Mutação 249Ser no TP53 no Carcinoma Hepatocelular (CHC), frequente em países da África e Ásia, é uma evidência molecular de exposição à aflatoxina. O objetivo deste estudo é analisar a freqüência de 249Ser em 74 amostras de CHC no Brasil. A mutação foi analisada por RFLP e sequenciamento. A presença de vírus da hepatite B (VHB) foi analisada por PCR em tempo real. 249Ser foi encontrada em 13/74 (28%) e VHB em 13/74 (16%). A mutação foi encontrada em maior freqüência em tumores indiferenciados (OR = 2,415, IC = 1,001 - 5,824). O tamanho médio de tumores com 249Ser foi de 9,4 cm contra 5,5 cm de amostras sem a mutação (p=0,012). Não foi encontrada relação entre VHB e 249Ser. Os resultados indicam que 249Ser é um fator importante na carcinogênese do CHC no Brasil sendo associada à uma forma maior e menos diferenciada de tumor. / TP53 249Ser mutation has been proved a molecular evidence for aflatoxin-related Hepatocellular Carcinoma (HCC) and is frequent in Africa and Asia. The aim of our study was to analyze the frequency of 249Ser mutation in HCC from Brazil. We studied 74 samples of paraffin embedded HCC. 249Ser mutation was analyzed by RFLP and sequencing. Presence of HBV DNA was determined by Real-Time PCR. 249Ser was found in 21/74 (28%) samples while HBV DNA was found in 13/74 (16%). Poorly differentiated HCC was more likely to have 249Ser mutation (OR = 2.415, IC = 1.001 - 5.824). The mean tumor size of 249Ser HCC was 9.4 cm versus 5.5cm on wild type (p=0.012). HBV DNA was not related with 249Ser. Results indicate that 249Ser is an important factor of HCC carcinogenesis in Brazil and is associated with large and poorly differentiated tumors.

Introdução: A injeção percutânea de etanol (PEI) é um método de ablação local considerado curativo para carcinomas hepatocelulares (CHC) pequenos. Não há dados sobre PEI para tratamento do CHC na América Latina. Pacientes e métodos: Incluídos 100 pacientes cirróticos submetidos à PEI como terapia primária para o CHC no Serviço de Gastroenterologia do HCFMUSP entre setembro de 1997 e dezembro de 2005. Avaliados resposta ao tratamento e taxa de sobrevida. Resultados: Resposta completa ao tratamento ocorreu em 41% dos casos. A sobrevida foi de 83% em 1 ano, 49% em 3 anos e 29% em 5 anos, mas no grupo com tumores de até 2 cm, sem invasão vascular e com resposta completa ao tratamento, atingiu 89%, 70% e 70%, respectivamente. Conclusão: PEI apresentou boa sobrevida em pacientes com tumores 2 cm, sem invasão vascular e resposta completa ao tratamento. / Introduction: Percutaneous ethanol injection (PEI) is a curative local ablative method for treatment of small hepatocellular carcinoma (HCC). There is no data about PEI for HCC treatment in Latin America. Patients and Methods: A total of 100 consecutive cirrhotic patients were enrolled. All of them had been submitted to PEI as first-line therapy for the treatment of HCC at the Service of Gastroenterology of HCFMUSP in the period of September 1997 to December 2005. Response to treatment and survival rates were assessed. Results: Complete response to treatment was obtained in 41% of the patients. Survival rates were 83% in 1 year, 49% in 3 years and 29% in 5 years, but in patients with tumors up to 2 cm, no vascular invasion and complete response to treatment, were 89%, 70% and 70%, respectively. Conclusion: PEI is associated with long-term survival in patients with tumors 2 cm, absence of vascular invasion and complete response to treatment

Avec près de 350 millions de personnes chroniquement infectées, et malgré l’existence de vaccins efficaces, le virus de l’Hépatite B (VHB) reste un problème majeur de santé publique. Parmi les protéines virales, la protéine régulatrice HBx possèdent des activités qui pourraient être particulièrement impliquées dans le développement de CHC. Au cours de ce travail, nous nous sommes intéressés aux différences biologiques entre la protéine HBx issue d’une région non tumorale (HBx-NT) et la protéine HBx issue d’une région tumorale (HBx-T) d’un même patient. En particulier, nous nous sommes intéressés à la régénération hépatique après hépatectomie partielle et à la carcinogenèse hépatique dans un modèle murin transgénique. Nous avons démontré l’absence d’impact de la forme tronquée de la protéine HBx sur la régénération hépatique. Nous avons démontré que la protéine HBx entière avait la capacité d’activer la sécrétion d’IL-6 dans la phase d’initiation de la régénération hépatique, conduisant à l’hyperactivation de STAT3, l’accumulation de SOCS3 et la diminution de phosphorylation de ERK. Au final, la protéine HBx entière induit un retard de régénération hépatique. Nous avons démontré une cinétique d’apparition de tumeurs plus rapide chez les souris HBx-T que chez les souris HBx-NT après injection d’un carcinogène chimique. Nous avons aussi pu observer que les deux formes HBx-T et HBx-NT sensibilisaient les hépatocytes à l’apoptose, au cours d’un dommage hépatique aigue, et que cette sensibilisation à l’apoptose pouvait en partie rendre compte de l’effet co-carcinogène observé chez les souris HBx-T et HBx-NT. L’ensemble de mes résultats a permis de mieux comprendre les mécanismes par lesquels la protéine HBx participe au développement de CHC. / Hepatitis B virus (HBV) is a worldwide health issue, as it is estimated that 350 millions people are chronically infected. Among the viral proteins, HBx is thought to be involved in hepatocellular carcinoma (HCC) development. In this work, we were interested in biological differences between HBx sequence from non tumoral region (HBx-NT) compared to HBx from tumoral region (HBx-T) from a single patient. In particular, we studied liver regeneration after partial hepatectomy et hepatocarcinogenesis in a transgenic mice model. We demonstrated that HBx-T did not modulate liver regenereation. We also showed that HBx-NT induced IL-6 overexpression during priming phase of liver regeneration, and that IL-6 overexpression was involved in STAT3 hyperactivation, SOCS3 accumulation and inhibition of ERK. Overall, HBx-NT induced IL-6 overexpression was responsible for a delay in liver regeneration. Moreover, we showed that HBx-T induced a faster development of hepatic tumor after DEN initiation, compared to HBx-NT. Both HBx forms were involved in an apoptosis sensibilization during acute liver injury, that could be involved in co-carcinogenic effect of HBx-T and HBx-NT. Overall, my results participate to the comprehension of HBx impact on liver carcinogenesis

Hepatitis B is one of the most common infectious diseases, which leads to public health problems in the world, especially in Asian counties. In recent years, extensive human genetic association studies have been carried out to identify susceptible genes and genetic polymorphisms to understand the genetic contributions to the disease progression of HBV infection. HLA-DQ gene variations have been reported to be associated with HBV infection/clearance, disease progression and the development of hepatitis B-related complications, including liver cirrhosis (LC) and hepatocellular carcinoma (HCC). However, the results are either inconclusive or controversial. Therefore, to derive a more precise estimation of the association, a meta-analysis was performed. Our data revealed that the HLA-DQ alleles rs2856718-G, rs7453920-A and rs9275319-G were significantly associated with decreased risk of HBV infection and HBV natural clearance. Logistic regression analyses showed that HLA-DQ alleles rs9275572-A significantly increased HBV infection clearance, and decreased HBV natural clearance. However, rs2856718-G and rs9275572-A were not associated with development of cirrhosis. The HLA-DQ polymorphisms (rs2856718 and rs9275572) were associated with a decreased HBV-related HCC risk in all genetic models, but rs9272105-A increased the risk of HBV-related HCC. In addition, no significant association was observed between HLA-DQ rs9275319-G polymorphism and HBVrelated HCC. These stratified analyses were limited due to relatively modest size of correlational studies. In future, further investigation on a large population and different ethnicities are warranted. Our findings contribute to the personalized care and prognosis in hepatitis B.

Le virus de l'hépatite C (HCV) est responsable de maladies chroniques du foie et l'une des principales causes de développement du carcinome hépatocellulaire (HCC). Cependant, les mécanismes moléculaires qui permettent le développement d’un HCC suite à une infection chronique par le HCV restent incompris. Les microARN (miR), de petits ARNs non codants qui régulent l'expression des gènes au niveau post-transcriptionnel, sont connus pour jouer un rôle important dans l'homéostasie cellulaire du foie. De plus en plus d’études suggèrent que l'infection par le HCV induit la modification de réseaux intracellulaires impliquant les miRs hépatiques contribuant au développement des lésions du foie, y compris le HCC. En utilisant des techniques d'analyse systématiques, nous avons identifié des miRs qui modulent le cycle viral du HCV mais également des miRs modulés lors de l'infection par le HCV. Cette analyse globale des interactions entre les miRs de l'hôte et le HCV améliore les connaissances actuelles sur les interactions entre le HCV et l’hôte qui contribuent vraisemblablement à la tumorigenèse dans le foie, et ouvre des perspectives pour de potentielles nouvelles approches pour prévenir et/ou traiter le HCC chez les patients infectés par le HCV. / Hepatitis C virus (HCV)-induced chronic liver disease is one of the leading causes of hepatocellular carcinoma (HCC). However, the molecular mechanisms that enable HCC development following chronic HCV infection remain poorly understood. MicroRNAs (miRs), small non coding RNAs that regulate gene expression at a post-transcriptional level have been reported to play an important role in cellular homeostasis within the liver. Increasing evidence suggests that HCV infection induces alteration of intrahepatic miR networks and that deregulation of miRs contributes to liver disease including HCC. Using high-throughput screening and RNA sequencing, we identified miRs that modulate the HCV life cycle and miRs that are modulated upon HCV infection. This comprehensive analysis of the HCV-host miR network improves the current knowledge of the HCV-host interactions that likely contribute to tumorigenesis in the liver and opens perspectives for novel potential approaches to prevent and/or treat HCC in HCV-infected patients.

La prévalence de l’obésité et du diabète de type 2 est en constante augmentation dans les pays industrialisés. Ces pathologies sont associées à des troubles de l’équilibre énergétique de l’organisme, ce qui se traduit au niveau hépatique par le développement de NAFLD (Non‐alcoholic Fatty Liver Disease). La NAFLD est engendrée par l’accumulation excessive de lipides dans les hépatocytes ou stéatose et est associée à la résistance à l’insuline. L’insulinorésistance hépatique est dite sélective car l’insuline n’est plus capable d’inhiber la production hépatique de glucose, contribuant à l’hyperglycémie, alors que la synthèse lipidique est exacerbée, induisant une stéatose hépatique. La stéatose peut évoluer en pathologies plus graves, telles que la fibrose, la cirrhose ou le cancer hépatocellulaire (CHC). L’objectif de ma thèse a été d’étudier les mécanismes moléculaires pouvant contribuer à la sélectivité de la résistance à l’insuline hépatique et à l’évolution de la stéatose simple vers le CHC. Dans un premier temps, nous avons étudié le rôle de l’adaptateur moléculaire Grb14, un inhibiteur de l’activité kinase du récepteur de l’insuline, dans la régulation du métabolisme hépatique chez la souris. L’invalidation de Grb14 dans le foie conduit d’une part à une activation de la signalisation de l’insuline et une amélioration de tolérance au glucose, et d’autre part à une diminution de la lipogenèse consécutive à l’inhibition du facteur lipogénique LXR via la voie Nrf2. L’invalidation de Grb14 dans le foie de souris obèses et diabétiques permet de ramener la glycémie et la stéatose hépatique à des valeurs similaires aux témoins. Ces données suggèrent que Grb14 est un nouvel acteur impliqué dans la sélectivité de la résistance à l’insuline du foie. La seconde étude a permis de montrer l’implication de la stéatose hépatique induite par un régime hypercalorique sur le développement de CHC. En effet, sur un fond génétique favorisant la carcinogenèse, un régime riche en graisse et en sucre contribuant à l’insulinorésistance hépatique accélère la cinétique d’apparition des tumeurs et augmente leur nombre. / The prevalence of metabolic diseases, including obesity and type 2 diabetes, are expanding in a worldwide epidemic way. These diseases are associated with metabolic disorders, resulting in the development of NAFLD (Non‐alcoholic Fatty Liver Disease) in the liver. NAFLD is generated by excessive accumulation of lipids in hepatocytes, and is associated with insulin resistance. In liver, insulin resistance leads to a blunted inhibitory action on hepatic glucose production, inducing hyperglycemia, whereas de novo lipogenesis, which is positively regulated by insulin, is paradoxically exacerbated, contributing to hepatic steatosis. Steatosis may also evolve into more serious diseases such as fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The aim of my thesis was to study the molecular mechanisms that may contribute to the selectivity of hepatic insulin resistance and the development of HCC. Initially, we studied the role of the molecular adapter Grb14, an inhibitor of the insulin receptor kinase activity, in the regulation of hepatic metabolism in mice. Invalidation of Grb14 in the liver leads on the one hand to an activation of the insulin signaling and improved glucose tolerance, and on the other hand to a decrease of LXR activity resulting in lipogenesis inhibition. Invalidation of Grb14 in the liver of obese and diabetic mice restores blood glucose levels and hepatic steatosis similar to control values. These data suggest that Grb14 is a new player involved in the selectivity of the insulin resistance in the liver. The second study demonstrated the involvement of hepatic steatosis induced by a high‐calorie diet on the development of HCC. Indeed, on a genetic background favoring carcinogenesis, a diet rich in fat and sugar contributing to hepatic insulin resistance accelerates appearance of tumors and increases their number.

Philosophiae Doctor - PhD / To ameliorate Hepatitis C Virus (HCV) therapeutic and diagnostic challenges requires robust intervention strategies, including approaches that leverage the plethora of rich data published in biomedical literature to gain greater understanding of HCV pathobiological mechanisms. The multitudes of metadata originating from HCV clinical trials as well as low and high-throughput experiments embedded in text corpora can be mined as data sources for the implementation of HCV-specific resources. HCV-customized resources may support the generation of worthy and testable hypothesis and reveal potential research clues to augment the pursuit of efficient diagnostic biomarkers and therapeutic targets. This research thesis report the development of two freely available HCV-specific web-based resources: (i) Dragon Exploratory System on Hepatitis C Virus (DESHCV) accessible via http://apps.sanbi.ac.za/DESHCV/ or http://cbrc.kaust.edu.sa/deshcv/ and (ii) Hepatitis C Virus Protein Interaction Database (HCVpro) accessible via http://apps.sanbi.ac.za/hcvpro/ or http://cbrc.kaust.edu.sa/hcvpro/. DESHCV is a text mining system implemented using named concept recognition and cooccurrence based approaches to computationally analyze about 32, 000 HCV related abstracts obtained from PubMed. As part of DESHCV development, the pre-constructed dictionaries of the Dragon Exploratory System (DES) were enriched with HCV biomedical concepts, including HCV proteins, name variants and symbols to enable HCV knowledge specific exploration. The DESHCV query inputs consist of user-defined keywords, phrases and concepts. DESHCV is therefore an information extraction tool that enables users to computationally generate association between concepts and support the prediction of potential hypothesis with diagnostic and therapeutic relevance. Additionally, users can retrieve a list of abstracts containing tagged concepts that can be used to overcome the herculean task of manual biocuration. DESHCV has been used to simulate previously reported thalidomide-chronic hepatitis C hypothesis and also to model a potentially novel thalidomide-amantadine hypothesis. HCVpro is a relational knowledgebase dedicated to housing experimentally detected HCV-HCV and HCV-human protein interaction information obtained from other databases and curated from biomedical journal articles. Additionally, the database contains consolidated biological information consisting of hepatocellular carcinoma (HCC) related genes, comprehensive reviews on HCV biology and drug development, functional genomics and molecular biology data, and cross-referenced links to canonical pathways and other essential biomedical databases. Users can retrieve enriched information including interaction metadata from HCVpro by using protein identifiers, gene chromosomal locations, experiment types used in detecting the interactions, PubMed IDs of journal articles reporting the interactions, annotated protein interaction IDs from external databases, and via “string searches”. The utility of HCVpro has been demonstrated by harnessing integrated data to suggest putative baseline clues that seem to support current diagnostic exploratory efforts directed towards vimentin. Furthermore, eight genes comprising of ACLY, AZGP1, DDX3X, FGG, H19, SIAH1, SERPING1 and THBS1 have been recommended for possible investigation to evaluate their diagnostic potential. The data archived in HCVpro can be utilized to support protein-protein interaction network-based candidate HCC gene prioritization for possible validation by experimental biologists. / South Africa

Le carcinome hépatocellulaire (CHC) est la principale forme de cancer primitif du foie. Le CHC présente des variations d'incidence géographique qui reflètent les variations de prévalence des infections chroniques par les virus de l'hépatite B (VHB) et/ou C (VHC), ainsi que l'exposition alimentaire aux aflatoxines. Dans les régions de haute incidence, une mutation spécifique au le codon 249 du gène TP53 est très fréquemment détectée dans les CHC et a été proposée comme un marqueur moléculaire de l'exposition aux aflatoxines. La protéine mutée correspondante, p.R249S, interagit avec l'oncogène viral HBx, qui module la réplication virale, la prolifération et la survie cellulaire. Des séquences HBX sont détectables dans l'ADN génomique de plus de 80% des CHC liés au VHB. Nous avons étudié les associations de mutation R249S avec les caractéristiques moléculaires de HBX et la progression du CHC en utilisant des spécimens obtenus dans deux études cas-témoins développées Thaïlande et en Gambie. Nos résultats démontrent (1) que la mutation R249S est préférentiellement associée aux CHC qui se développent en l'absence de cirrhose hépatique préexistante ; (2) que la mutation est associée à la présence de polymorphismes dans l'intron 1 de TP53, suggérant l'influence de facteurs de susceptibilité génétique sur la formation des mutations ; (3) que la mutation est généralement associée à la rétention dans les cancers de séquences de HBX complètes. Ces résultats suggèrent que la protéine mutée p.R249S coopère avec HBx pour favoriser le développement de CHC sans cirrhose, et que la susceptibilité à la formation de cette mutation est influencée par la structure polymorphique de TP53 / Hepatocellular carcinoma (HCC) is the main form of primary liver cancer. HCC presents geographical variations in incidence that reflect variations in the prevalence of chronic infections by hepatitis B virus (HBV) and / or C (HCV) and dietary exposure to aflatoxins. In areas of high incidence, a specific mutation at codon 249 of TP53 gene is frequently detected in HCC and has been proposed as a molecular hallmark of aflatoxin exposure. The corresponding mutated protein p.R249S, interacts with the viral oncogene HBx, which modulates viral replication, proliferation and cell survival. HBX sequences are detectable in the genomic DNA of more than 80% of HBVrelated HCC. We investigated the associations of mutation R249S with the molecular characteristics of HBX and progression of HCC using specimens obtained in two case-control studies developed in Thailand and in The Gambia. Our results demonstrate (1) that the mutation R249S is preferentially associated with HCC that develop in the absence of pre-existing liver cirrhosis, (2) that the mutation is associated with the presence of polymorphisms in intron 1 of TP53, suggesting influence of genetic susceptibility factors on the formation of mutations, (3) that the mutation is usually associated with the retention of cancers with complete HBX sequences. These results suggest that the mutated protein p.R249S cooperates with HBx to promote the development of HCC without cirrhosis, and that susceptibility to the formation of this mutation is influenced by the polymorphic structure of TP53

Astrocyte Elevated Gene 1 (AEG1) is an oncogene for hepatocellular carcinoma (HCC). Its role in HCC pathogenesis has been well studied. A pan cancer analysis of gene expression in multiple databases identified TATA-box binding protein associated factor 2 (TAF2) as the gene that is most frequently co-expressed with AEG1. TAF2 is a protein that is involved in transcription of genes by RNA polymerase II. It is a factor that is dispensable for basal transcription but, required for activated transcription. It has also been shown to be involved in regulating cyclin levels and hence cell cycle progression. Bioinformatic analysis on data from different cancer databases confirmed the positive correlation of TAF2 expression with AEG1 expression, the over expression of TAF2 in HCC patients and poor survival of HCC patients with increasing TAF2. We confirmed the over expression of TAF2 in HCC cell lines using western blotting and HCC liver using immunohistochemistry. We established cell lines with stable knockdown of TAF2 expression. These clones showed significant decrease in their ability to invade and migrate but not their proliferation ability. This is in contrast to what has been observed in previous studies. We hypothesize that the knockdowns do not show any decrease in cellular proliferation since the remaining TAF2 in the cells is sufficient to produce cyclins and keep cell cycle undisturbed. The knockdown of TAF2 causes an increase in E-cadherin level and decrease in Snail protein expression which is a known negative regulator of E-cadherin. Knockdown of TAF2 causes cells to become more epithelial leading to a decrease in their ability to migrate and invade. This study shows that TAF2 is a potential oncogene that needs to be further studied.

Le carcinome hépatocellulaire (CHC) est un cancer très fréquent - au 5ème rang de l’échelon mondial - dont l’incidence ne cesse d’augmenter. Lié aux maladies chroniques du foie (hépatite C, syndrome métabolique et, le plus souvent, cirrhose), il représente désormais un véritable problème de santé publique. C’est la nature du foie sous-jacent qui détermine les modalités de sa prise en charge. Lorsque le foie ne présente pas de maladie chronique (foie sain), on se trouve généralement devant une tumeur déjà évoluée; dans ce cas on a recours essentiellement à la résection hépatique. Lorsque le foie présente une maladie chronique (foie pathologique), qu’il s’agisse de fibrose, cirrhose ou hépatite, c’est le stade tumoral au moment du diagnostic qui oriente le choix du traitement ; à part la transplantation, limitée dans ses indications, les options thérapeutiques comportent la résection hépatique, la destruction par voie sous-cutanée (radio fréquence) et un traitement par voie artérielle (chimioembolisation). Cependant, ces traitements à visée curative, ne peuvent être envisagés actuellement que dans 30% des cas. Notre travail porte uniquement sur la résection hépatique. Partout disponible, cette intervention chirurgicale représente en effet le traitement de référence dans la prise en charge du CHC. Nous nous appuyons sur une vaste enquête nationale qui, développée sur une période de 15 ans – de 1990 à 2005 – à partir de 23 centres de chirurgie, à porté sur plus de 2590 dossiers de patients. Grâce à ces données de base, particulièrement précieuses par leur nombre et leur précisions, nous avons tenté de donner une image panoramique des pratiques (indications, techniques opératoires) et des résultats (survie, récidive, morbidité, mortalité) de la résection hépatique pour CHC en France. Il s’agit de la plus grande étude multicentrique chirurgicale menée sur le CHC en France à ce jour. On a classé 102 paramètres dans 6 groupes de données ont été colligés pour chaque malade inclus dans l’étude: Terrain, Bilan préopératoire, Chirurgie, Anatomopathologie, Morbidité et traitements adjuvants et Evolution. Au total, cette enquête a permis de recueillir une somme considérable de données dont l’analyse multivariée avait pour l’objectif d’aboutir à des critères prédictifs de mortalité opératoire et de survie après résection sur foie sain et pathologique. Cette analyse a confirmé le développent et la qualité de la chirurgie hépatique en France. Aussi, l’analyse a montré que la résection hépatique est un traitement efficace du CHC sur foie sain et pathologique. Ces résultats et leur implication pour l’approche multidisciplinaire en cancérologie contribueront à améliorer les connaissances et la prise en charge du CHC. Finalement, à coté de la transplantation hépatique, limitée par ses indications restreintes et la pénurie de greffons, la résection du CHC occupe une place importante qui doit continuer de croître du fait de ses bons résultats et de l’augmentation constante de l’incidence du CHC / Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, and the third most common cause of cancer-related death. It is a major health problem worldwide, which represents the most prevalent primary liver cancer and constitutes the third most frequent cause of cancer-related deaths. The major risk factor for HCC is cirrhosis. All types of cirrhosis predispose to HCC, but the incidence is particularly high in persistent infection with hepatitis B (HBV) and hepatitis C (HCV) and in alcoholic liver disease. The clinical presentation and management of HCC depends on whether the liver is cirrhotic and whether there is underlying viral hepatitis. Therapeutic options fall into four main categories (1) surgical interventions, including tumor resection and liver transplantation, (2) percutaneous interventions, including ethanol injection and radiofrequency thermal ablation, (3) transarterial interventions, including embolisation and chemoembolisation and (4) drugs as well as gene and immune therapies. Potentially curative therapies are tumor resection, liver transplantation, and percutaneous interventions that can result in complete responses and improved survival in a high proportion of patients. Liver resection offers the greatest impact on survival when patients do not meet transplantation criteria and this is considered as the optimal treatment for HCC. The objective of this thesis, based on a retrospective survey, was to give an overview on conditions of realization and the results of the resection of HCC in France, in the period from 1990-2005. All the French centers of excellence in the hepatobiliary surgery were contacted and most of them accepted to participate. All the contacted units were essentially localized in University Clinical Centers, all of them experts in hepatic surgery and most of them were centers for liver transplantation. More than 2590 cases with hepatic resection were collected in this study. The file consisted of 102 questions and contained following headings: demographic data, underlined liver pathology, circumstances of diagnosis, imaging, evaluation of underlined liver pathology: biological, morphological, histological, preparation for resection: neoadjuvant treatment of the tumor, portal embolization, surgical intervention: approach, clamping, vascular control, nature and the extent of the exeresis, anatomic or non-anatomic features, histopathological analysis of the removed tissues, results: mortality, morbidity, recurrence, survival, lost from analysis. In total, this survey enabled us to collect a considerable sum of data in order to give a more precise overview on predictive criteria of per operative mortality and survival, as well as recurrence rates, after the resection of normal and pathological livers. It confirmed the development and the quality of the hepatic surgery in France