Hepatocellular carcinoma: Which major advances in these last years?

La stéatopathie métabolique semble en cause dans 20 % des cas de carcinome hépatocellulaire (CHC). Des signatures génomiques constatées dans la tumeur ou dans le foie non tumoral sont des facteurs prédictifs de récidive. Le sorafénib prolonge la survie des malades atteints de CHC évolué. De nouvelles molécules, de nouvelles indications du sorafénib et des critères prédictifs de l’efficacité des médicaments sont en cours d’évaluation. Faute d’une surveillance optimale des malades atteints de cirrhose, 30 % seulement des CHC sont diagnostiqués à un stade précoce. La radiofréquence peut être considérée comme un traitement curatif de première intention. Les résultats de la résection hépatique s’améliorent en termes de récidive et de survie. Une extension des critères de sélection des patients pour la transplantation a été proposée. Une faible proportion des patients atteints de CHC bénéficie actuellement de ce traitement curatif. La stratégie de premier traitement curatif suivi de transplantation en cas de récidive, n’entraîne pas de perte de chances pour les patients. La radiothérapie focalisée à haute dose et la radioembolisation ont donné des résultats prometteurs lors d’études préliminaires.The metabolic syndrome seems the main risk factor in 20% of the cases of hepatocellular carcinoma (HCC). Genomic signatures in the tumor or in the surrounding liver are predictive factors of recurrence. Sorafenib prolongs survival in patients with advanced HCC. New molecules, new indications of sorafenib and predictive criteria of efficiency are under evaluation. Due to lack of an optimal surveillance of patients with cirrhosis, only 30% HCC are currently diagnosed at an early stage. Radiofrequency can be considered as a first intention curative treatment. The results of hepatic resection recently improved in terms of recurrence and of survival. An extension of the selection criteria for transplantation was proposed. A small proportion of patients with HCC currently benefits from this curative treatment. The strategy of a first curative treatment followed by transplantation in case of recurrence is not associated with a loss of chances for the patients. High-dose focused radiotherapy and radioembolization gave promising results in preliminary studies

Eighth Major Clade for Hepatitis Delta Virus

Hepatitis delta virus is the only representative of the Deltavirus genus, which consists of 7 differentiated major clades. In this study, an eighth clade was identified from 3 distinct strains. Deltavirus genetic variability should be considered for diagnostic purposes. Clinical consequences of the diversity have yet to be evaluated

HISTOIRE NATURELLE ET FACTEURS PRONOSTIQUES DU PETIT CARCINOME HEPATOCELLULAIRE ISOLE CHEZ LES MALADES ATTEINTS DE CIRRHOSE APPARTENANT A LA CLASSE A DE CHILD-PUGH

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Histoire naturelle du carcinome hépatocellulaire sur cirrhose (dépistage, facteurs prédictifs et facteurs pronostiques)

Le carcinome hépatocellulaire est un problème majeur de santé publique car son incidence et sa mortalité sont croissantes. Compte tenu du pourcentage encore trop faible de malades éligibles pour un traitement curatif, la stratégie s'oriente vers une prise en charge en amont la plus précoce possible. Cette stratégie se fonde essentiellement sur le dépistage et sur l'identification de facteurs prédictifs de survenue du carcinome hépatocellulaire chez les malades atteints de cirrhose : - En ce qui concerne le dépistage, un travail a évalué son efficacité chez des malades caucasiens et un second a décrit les pratiques actuelles en France. - En ce qui concerne l'identification de facteurs prédictifs, cinq travaux sont présentés. Deux publications supplémentaires concernent le pronostic du carcinome hépatocellulaireLYON1-BU.Sciences (692662101) / SudocSudocFranceF

Do genetic variations in antioxidant enzymes influence the course of hereditary hemochromatosis?

International audienceIron-induced oxidative stress promotes hepatic injury in hereditary hemochromatosis, which can be influenced by genetic traits affecting antioxidant enzymes. We assessed the influence of Ala16Val-superoxide dismutase 2, Pro198Leu-glutathione peroxidase 1, and -463G/A-myeloperoxidase genotypes (high activity for the Ala, Pro, and G alleles, respectively) on the risks of cirrhosis and hepatocellular carcinoma (HCC) in patients homozygous for the C282Y-hemochromatosis (HFE) gene mutation. Both the 2G-myeloperoxidase genotype and carriage of one or two copies of the Ala-superoxide dismutase 2 allele were more frequent in patients with cirrhosis or HCC. Patients cumulating these two genetic traits had higher rates of cirrhosis and HCC than other patients

Hepatocellular Carcinoma and Occupation in Men: A Case-Control Study.

International audienceOBJECTIVE:: The principal objective of this work was to evaluate the association between the risk of hepatocellular carcinoma (HCC) and various occupations. METHODS:: This case-control study, conducted during 2000 to 2003 in four French hospitals, included 125 men younger than 75 years with incident HCC and 142 men as control subjects. RESULTS:: An association with HCC was observed for machinery fitters and machine assemblers (odds ratio [OR] = 4.4 [1.0-19.0], eight exposed cases and three exposed controls). A higher percentage of cases than controls were metal machinists (OR = 2.2 [0.8-5.8], 14 exposed cases and 10 exposed controls), although the difference was not statistically significant. These associations were strongest for subjects with duration of employment greater than 20 years. CONCLUSIONS:: Our findings suggest an association between metal machining jobs and hepatocellular carcinoma, although we cannot rule out the possibility that it was observed by chance

Chemokine system polymorphisms, survival and hepatocellular carcinoma occurrence in patients with hepatitis C virus-related cirrhosis

AIM: To explore the influence of polymorphisms in genes encoding for the chemokines Stromal cell-Derived Factor-1 (SDF-1)/CXCL12 and Monocyte Chemotactic Protein-1 (MCP-1)/CCL2, or for the chemokine receptor CCR5 on the risks of liver-related death and hepatocellular carcinoma (HCC) occurrence in hepatitis C virus (HCV)-infected patients

Metabolomic approach by (1)h NMR spectroscopy of serum for the assessment of chronic liver failure in patients with cirrhosis

1 - ArticleAssessment of chronic liver failure (CLF) in cirrhotic patients is needed to make therapeutic decisions. A biological score is usually performed, using the Model for End-Stage Liver Disease (MELD), to evaluate CLF. Nevertheless, MELD does not take into account metabolic perturbations produced by liver-function impairment. In contrast, metabolomics can investigate many metabolic perturbations within biological systems. The purpose of this study was to assess whether metabolomic profiles of serum, obtained by proton NMR spectroscopy from cirrhotic patients, are affected by the severity of CLF. An orthogonal projection to latent-structure analysis was performed to compare MELD scores and NMR spectra of 124 patients with cirrhosis. The statistical model obtained showed a good explained variance (R(2)X = 0.87 and R(2)Y = 0.86) and a good predictability (Q(2)Y = 0.64). Metabolomic profiles showed significant differences regarding various metabolites depending of severity of CLF: levels of high-density lipoprotein and phosphocholine resonances were significantly higher in patients with mild CLF compared to severe CLF. Other metabolites such as lactate, pyruvate, glucose, amino acids, and creatinine were significantly higher in patients with severe CLF than mild CLF. Our conclusion is that metabolomic NMR analysis provides new insights into metabolic processes related to the severity of hepatic function impairment in cirrhosis