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Etude des facteurs nutritionnels et métaboliques de la cancérogenèse hépatique chez des patients atteints de cirrhose

Abstract : Hepatocellular Carcinoma (HCC) is worldwide the 5th most common diagnosed cancer in men and the 7th in women and the 4th cause of cancer death with a median survival between 10 and 11 months. The incidence rate in France is relatively high (7.8/100 000 with 10 624 estimated new cases in 2018). HCC prognosis is very poor due to the difficulty to diagnose it at an early stage. Around 80% of HCC occur in the setting of cirrhosis, mainly caused by alcoholism, chronic infections with HBV and HCV or metabolic syndrome. Cirrhotic patients have a high-risk to develop chronic inflammation or other liver complications that can progress toward cancer. Thus, it is important to identify the risk factors of these complications, and mainly HCC, in this specific population in order to define preventive tools.Diet is composed of several bioactive components and represents a modifiable factor with preventive potential. Associations between dietary factors and HCC risk have been little investigated and results were conflicting. It has been suggested that some foods, such as fruit, vegetables, fish and white meat, have a protective effect, whereas red and processed meat seem to be associated with an elevated risk of HCC. Strong evidence exists only for the relationship between liver carcinogenesis and coffee consumption. The previous results require confirmation especially in occidental countries and in such a high-risk population suffering from cirrhosis, for which food choices may differ.The French multicenter case-control study CiRCE (main investigator: Pr Hillon) was conducted to identify the environmental, nutritional and metabolic risk factors of developing HCC in cirrhotic patients with different etiologies. This study is coordinated by the EPICAD team from the National Institute for Health and Medical Research Inserm UMR1231 “Lipid Nutrition Cancer” with the collaboration of the Clinical Investigation Center of Dijon CHU. Between June 2008 and December 2012, cirrhotic patients with HCC (428 cases) or without HCC (760 controls) were recruited in six academic hospitals of the North-East of France (Besancon, Dijon, Metz, Nancy, Reims and Strasbourg). In addition to clinical data, every patient has to fill a diet history questionnaire that included 208 food items. A biobank has been also constituted.The comparisons between cases and controls allow investigating the HCC risk in cirrhotic patients.All these data are of great interest to investigate the relationships between dietary and metabolic factors and the risk of HCC or occurrence of complications in cirrhotic patients.
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Maud Rizk-El Zraiby. Etude des facteurs nutritionnels et métaboliques de la cancérogenèse hépatique chez des patients atteints de cirrhose. Médecine humaine et pathologie. Université Bourgogne Franche-Comté, 2019. Français. ⟨NNT : 2019UBFCI007⟩. ⟨tel-02421089⟩

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