Prior surveillance and antiviral treatment improve the prognosis of HCC developed in HBV patients in the West.

BACKGROUND: In Western countries, hepatocellular carcinoma (HCC) in hepatitis B (HBV) patients without cirrhosis was poorly studied. The aim was to describe the characteristics and outcome of HBV-related HCC according to fibrosis stage. METHOD: All patients with chronic HBV infection and HCC discussed in a multidisciplinary tumor board between 2007 and 2017 were retrospectively included. RESULTS: A total of 152 out of 2,038 HCC patients had underlying HBV infection. HBV viral load>2000IU/ml, positive HBeAg and Hepatitis D coinfection were observed in 41%, 13% and 13% of cases, respectively. HCC was uninodular in 53%, associated with portal thrombosis in 16% and/or metastasis in 9% of cases. 130 patients (86%) had cirrhosis. No difference regarding HCC risk factors and viral characteristics was observed according to fibrosis stage. 5-year survival was 48%(47% on cirrhosis versus 57% without cirrhosis, P=0.26). At HCC diagnosis, 47% and 32% of cirrhotic and non-cirrhotic patients received an antiviral treatment (AVT), which was associated with less aggressive tumor and better survival (P=0.005). In cirrhosis, screening was associated with a lower tumor burden and patients were more amenable to curative treatment with better outcome (P<0.001). CONCLUSION: HBV represents 8% of HCC etiologies without differences of viral characteristics according to fibrosis stage. AVT and surveillance were associated with less aggressive tumors, better access to curative treatment and outcome.

Management and surveillance of compensated cirrhosis / Prise en charge et surveillance des cirrhoses compensées

Management and surveillance of compensated Cirrhosis. Patients with compensated cirrhosis are now identified early using non-invasive fibrosis tests. Therapeutic advances in hepatology, in particular antiviral agents, have changed their prognosis by dramatically reducing the occurrence of liver complications, whether hepatic decompensation or hepatocellular carcinoma. Moreover, the latter, when managed early, have also been the subject of major therapeutic advances, thus explaining the longer survival of cirrhotic patients. Finally, management of comorbidities frequently encountered in these patients, is also key in their follow-up. Thus, surveillance and early detection of life-threatening complications such as portal hypertension or liver cancer are major stakes in these patients, who will benefit from a multidisciplinary management.

Prise en charge et surveillance des cirrhoses compensées. Les patients ayant une cirrhose compensée sont désormais identifiés de façon précoce par les tests non invasifs de fibrose. Les progrès des traitements étiologiques, notamment antiviraux, ont profondément bouleversé leur pronostic en diminuant de façon drastique la survenue de complications hépatiques, que ce soit les décompensations ou le carcinome hépatocellulaire. Par ailleurs, ces dernières, lorsqu'elles sont prises en charge de façon précoce, ont également fait l'objet d'avancées thérapeutiques majeures, expliquant ainsi la survie plus longue de ces patients. Enfin, la prise en charge des comorbidités, fréquentes chez ces malades, fait partie intégrante de leur suivi. Ainsi, la surveillance et le diagnostic précoce des complications graves comme l'hypertension portale ou le carcinome hépatocellulaire sont les enjeux majeurs chez ces patients, qui bénéficieront d'une prise en charge multidisciplinaire.