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Geographical Disparities of Outcomes of Hepatocellular Carcinoma in France: The Heavier Burden of Alcohol Compared to Hepatitis C

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Abstract

Background

Data on alcohol-related HCC are limited.

Aims

Our aim was to describe the incidence, management, and prognosis of alcohol compared to Hepatitis C (HCV)-related HCC at a national level.

Methods

Incident cases of HCC were identified in French healthcare databases between 2009 and 2012 and analyzed retrospectively. Demographic data, type, location, and annual HCC-caseload of the hospitals where patients were first managed were retrieved. Survival of incident cases was computed from the time of diagnosis and adjusted for potential confounding variables.

Results

The study population included 14,060 incident cases of alcohol and 2581 HCV-related HCC. Alcohol-related HCC was more frequent than HCV-related HCC (29.37 and 5.39/100,000 adults/year, respectively) with an heterogeneous distribution on the French territory. The optimal treatment was less frequently curative (20.5% vs 35.9%; p < 0.001), and survival was significantly shorter (9.5 [9.0–10.0] versus 16.8 [15.5–18.7] months p < 0.001) in alcohol compared to HCV-related HCC, with marked variations between regions for a given risk factor. In multivariable analysis in the whole study population, curative treatment was a strong predictor of survival (adjusted HR 0.28 [0.27–0.30] months p < 0.001). Being managed at least once in a teaching hospital during follow-up was independently associated with receiving a curative treatment and survival.

Conclusion

In France, incidence of alcohol-related HCC is high and prognosis is poor compared to HCV-related HCC, with marked variations between regions. These results should guide future health policy initiatives pertaining to HCC care. Importantly, increasing patient’ referral in expert centers could increase chances to receive curative treatment and improve outcomes.

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Abbreviations

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HBV:

Hepatitis B virus

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

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Author information

Authors and Affiliations

  1. Clinique Universitaire d’Hépato-gastroentérologie, Pôle Digidune, University Hospital Grenoble Alpes, La Tronche, France

    Charlotte E. Costentin

  2. Grenoble Alpes University, Inserm U1041, Grenoble, France

    Charlotte E. Costentin

  3. INSERM U-1223, Pasteur Institute, Paris and Hepatology, Cochin Hospital, Assistance Publique – Hopitaux de Paris, France, Paris-Descartes University, Paris, France

    Philippe Sogni

  4. Biostatistics, Paris-Sud University, INSERM, Paris, France

    Bruno Falissard

  5. Amiens University Hospital, délégation à la recherche clinique et à l’innovation, site sud, 80054, Amiens, France

    Jean-Claude Barbare

  6. Medical Informatics, Beaujon Hospital, Clichy, France

    Noelle Bendersky

  7. Hepato-biliary Surgery, Beaujon Hospital, Clichy, France

    Olivier Farges

  8. Paris XI University, INSERM UMRS-1193, DHU Hépatinov and Centre hépatobiliaire, Paul-Brousse Hospital, Assistance Publique – Hôpitaux de Paris, Villejuif, France

    Nathalie Goutte

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Contributions

Costentin, Sogni, Goutte had full access to all data in the study and take responsibility for the integrity of data and the accuracy of data analysis. Study concept and design: Costentin, Sogni and Goutte. Acquisition of data: Bendersky, Farges, Goutte. Analysis and interpretation of data: Costentin, Sogni and Goutte. Drafting of the manuscript: Costentin, Sogni and Goutte. Statistical analysis: Goutte, Falissard. Study supervision: Costentin, Sogni and Goutte. Critical revision and approval of the manuscript: Costentin, Sogni, Falissard, Bendersky, Farges, Goutte, Barbare.

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Correspondence to Charlotte E. Costentin.

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Costentin, C.E., Sogni, P., Falissard, B. et al. Geographical Disparities of Outcomes of Hepatocellular Carcinoma in France: The Heavier Burden of Alcohol Compared to Hepatitis C. Dig Dis Sci 65, 301–311 (2020). https://doi.org/10.1007/s10620-019-05724-1

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