Validation of the prognostic value of histologic scoring systems in primary sclerosing cholangitis: An international cohort study.

Détails

ID Serval
serval:BIB_1CF36BEA7995
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Validation of the prognostic value of histologic scoring systems in primary sclerosing cholangitis: An international cohort study.
Périodique
Hepatology
Auteur(s)
de Vries E.M., de Krijger M., Färkkilä M., Arola J., Schirmacher P., Gotthardt D., Goeppert B., Trivedi P.J., Hirschfield G.M., Ytting H., Vainer B., Buuren H.R., Biermann K., Harms M.H., Chazouilleres O., Wendum D., Kemgang A.D., Chapman R.W., Wang L.M., Williamson K.D., Gouw A.S., Paradis V., Sempoux C., Beuers U., Hübscher S.G., Verheij J., Ponsioen C.Y.
ISSN
1527-3350 (Electronic)
ISSN-L
0270-9139
Statut éditorial
Publié
Date de publication
03/2017
Peer-reviewed
Oui
Volume
65
Numéro
3
Pages
907-919
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Validation Studies
Publication Status: ppublish
Résumé
Histologic scoring systems specific for primary sclerosing cholangitis (PSC) are not validated. We recently determined the applicability and prognostic value of three histological scoring systems in a single PSC cohort. The aim of this study was to validate their prognostic use and reproducibility across a multicenter PSC cohort. Liver biopsies from PSC patients were collected from seven European institutions. Histologic scoring was performed using the Nakanuma, Ishak, and Ludwig scoring systems. Biopsies were independently scored by six liver pathologists for interobserver agreement. The prognostic value of clinical, biochemical, and all three histologic scoring systems on predicting composite endpoints 1 (PSC-related death and liver transplantation), 2 (liver transplantation), and 3 (liver-related events), was assessed using univariable and multivariable Cox proportional hazards modeling. A total of 119 PSC patients were identified, and the median follow-up was 142 months. During follow-up, 31 patients died (20 PSC-related deaths), 31 patients underwent liver transplantation, and 35 patients experienced one or more liver-related events. All three staging systems were independent predictors of endpoints 2 and 3 (Nakanuma system: hazard ratio [HR], 3.16 [95% confidence interval (CI), 1.49-6.68] for endpoint 2 and HR, 2.05 [95% CI, 1.17-3.57] for endpoint 3; Ishak system: HR, 1.55 [95% CI, 1.10-2.18] for endpoint 2 and HR, 1.43 [95% CI, 1.10-1.85] for endpoint 3; Ludwig system: HR, 2.62 [95% CI, 1.19-5.80] for endpoint 2 and HR, 2.06 [95% CI, 1.09-3.89] for endpoint 3). Only the Nakanuma staging system was independently associated with endpoint 1: HR, 2.14 (95% CI, 1.22-3.77). Interobserver agreement was moderate for Nakanuma stage (κ = 0.56) and substantial for Nakanuma component fibrosis (κ = 0.67), Ishak stage (κ = 0.64), and Ludwig stage (κ = 0.62).
We confirm the independent prognostic value and demonstrate for the first time the reproducibility of staging disease progression in PSC using the Nakanuma, Ishak, and Ludwig staging systems. The Nakanuma staging system-incorporating features of chronic biliary disease-again showed the strongest predictive value. (Hepatology 2017;65:907-919).

Mots-clé
Adult, Biopsy, Needle, Cholangitis, Sclerosing/mortality, Cholangitis, Sclerosing/pathology, Cholangitis, Sclerosing/surgery, Cohort Studies, Female, Humans, Immunohistochemistry, Internationality, Kaplan-Meier Estimate, Liver Transplantation/methods, Liver Transplantation/mortality, Male, Middle Aged, Multivariate Analysis, Observer Variation, Prognosis, Proportional Hazards Models, Risk Assessment, Severity of Illness Index, Survival Rate, Treatment Outcome
Pubmed
Web of science
Création de la notice
25/11/2016 14:50
Dernière modification de la notice
03/03/2018 14:33
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