title: Effect of long-term propranolol treatment on hepatocellular carcinoma incidence in patients with HCV-associated cirrhosis.
abstract: Propranolol bears antioxidant, anti-inflammatory, and antiangiogenic properties and antitumoral effects and therefore is potentially active in the prevention of hepatocellular carcinoma (HCC). We retrospectively assessed the impact of propranolol treatment on HCC occurrence in a cohort of 291 patients with compensated viral C (HCV) cirrhosis, prospectively followed and screened for HCC detection. Of the 291 patients included in the cohort, 93 patients [50 males: mean age, 59.5 ± 12 years; body mass index (BMI), 25.7 ± 4.4 kg/m(2); and platelet count, 111 ± 53 Giga/L] developed esophageal varices (OV) or had OV at inclusion and 198 patients (111 males: mean age, 55.8 ± 13 years; BMI, 25.7 ± 5 kg/m(2); platelet count, 137 ± 59 Giga/L) did not. Among patients with OV, 50 received treatment by propranolol. During a median follow-up of 54 months interquartile range (32-82), 61 patients developed an HCC. The 3- and 5-year HCC incidence was 4% and 4%, and 10% and 20% for patients treated and not treated by propranolol, respectively (Gray test, P = 0.03). In multivariate analysis, propranolol treatment was associated with a decrease risk of HCC occurrence [HR, 0.25; 95% confidence interval (CI), 0.09-0.65; P = 0.004], and was the only independent predictive factor of HCC occurrence in patients with OV (HR, 0.16; CI, 0.06-0.45; P = 0.0005). The benefit of propranolol was further supported by propensity scores analyses.
  
  
  CONCLUSIONS
  This retrospective long-term observational study suggests that propranolol treatment may decrease HCC occurrence in patients with HCV cirrhosis. These findings need to be verified by prospective clinical trial.
authors.affiliation: Service d'Hépatogastroenterologie, Hôpital Jean Verdier, avenue du 14 juillet, Bondy 93143 cedex, France. gisele.nkontchou@jvr.ap-hop-paris.fr
authors.forename: Gisèle
authors.initials: G
authors.lastname: Nkontchou
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Amel
authors.initials: A
authors.lastname: Mahmoudi
authors.forename: Dominique
authors.initials: D
authors.lastname: Roulot
authors.forename: Valérie
authors.initials: V
authors.lastname: Bourcier
authors.forename: Véronique
authors.initials: V
authors.lastname: Grando-Lemaire
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrie
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000472:pathogenicity; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000821:virology*; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011433:Propranolol / Q000009:adverse effects*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D014665:Vasodilator Agents / Q000009:adverse effects*
chemical_list: D014665:Vasodilator Agents; D011433:Propranolol