Cirrhosis Clinical Trial
Official title:
Use of the French Healthcare Insurance Database to Evaluate How Early Diagnosis of Hepatocellular Carcinomas is Implemented in France: SAMHEPAT Study
Hepatocellular carcinoma (HCC) has become the second most common cause of cancer death in the world, estimated responsible for nearly 745,000 deaths in 2012 (9.1% of all cancer deaths).
Hepatocellular carcinoma (HCC) has become the second most common cause of cancer death in the
world, estimated responsible for nearly 745,000 deaths in 2012 (9.1% of all cancer deaths).
This cancer is closely associated with the presence of chronic liver underlying disease and
early diagnosis following a systematic surveillance of cirrhotic patients could improve
disease-free survival in patients declaring HCC. However, the risk-benefit ratio of such
monitoring is discussed. Nevertheless, it is recommended in patients with liver cirrhosis,
from which the prevalence is estimated between 0.3% and 0.6% in the French population. This
debate can lead to a failure to comply with recommendations and promote a large variability
in the management of the surveillance of HCC in patients with cirrhosis in practice. Data
acquisition regarding the current situation in France is required.
The objective of this project is to use this database to document current practices
concerning monitoring of incidents HCC in cirrhotic patients in France. A retrospective
cohort study will be conducted on data from SNIIRAM recorded between 2007 and 2015. The
primary analysis will focus on multivariate modelling of the deviation rate from the
recommendations (advising the realisation of at least two echodoppler ultrasonographies
yearly) with a competitive risk model, taking into account gender, social status, Charlson
index, age at baseline, the alcoholic etiology of cirrhosis, type of facility and the yearly
number of visits to a hepatologist during follow-up. It is estimated that more than 86,000
patients with a minimum follow-up of 3 years will be included in the analysis
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