Toyoda H, Kumada T, Tokuda A, Horiguchi Y, Nakano H, Honda T, Nakano S, Hayashi K, Katano Y, Nakano I, Hayakawa T, Nishimura D, Kato K, Imada K, Imoto M, Fukuda Y
Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
J Viral Hepat. 2000 Nov;7(6):414-9. doi: 10.1046/j.1365-2893.2000.00241.x.
Interferon (IFN) therapy has been proven to induce the normalization of serum alanine aminotransferase (ALT) levels and to eradicate the hepatitis C virus (HCV) in some patients with chronic hepatitis C, and these patients are usually defined as 'sustained responders'. However, there have been some reports of hepatocellular carcinoma (HCC) in these patients, and the development of HCC remains life-threatening in patients who clear HCV. We analysed the long-term prognoses of patients with chronic hepatitis C in whom HCV was eradicated with IFN. We investigated 392 sustained responders to IFN therapy, from 1,277 patients with chronic HCV infection who received IFN treatment at one of our institutions between April 1989 and March 1999. We analysed the medical records and looked for the development of HCC. About 30% of the sustained responders had been lost to follow-up 3 years after the end of IFN therapy, and the follow-up rate of sustained responders was significantly lower than that of non-sustained responders (P < 0.0001). HCC were found in eight patients: in seven patients HCC developed within 5 years after completion of IFN therapy; but in one patient, a single HCC less than 3 cm in diameter was detected between 7 and 8 years after completion of IFN. Of the five patients who had regular medical follow-up, the HCC was solitary, and the patients survived without any evidence of recurrence. Of the three patients who had not been followed-up, two died from HCC and HCC recurred in the third. These results suggest that HCC can develop in sustained responders and that sustained responders should be followed-up closely after completion of IFN so that HCC may be detected at an early stage. The optimal duration of the follow-up period of the sustained responders remains unclear. Additional prospective studies are required in order to establish an appropriate follow-up protocol for sustained responders to IFN.
干扰素（IFN）治疗已被证明可使部分慢性丙型肝炎患者的血清丙氨酸氨基转移酶（ALT）水平恢复正常，并清除丙型肝炎病毒（HCV），这些患者通常被定义为“持续应答者”。然而，已有报道称这些患者中出现了肝细胞癌（HCC），对于清除HCV的患者，HCC的发生仍然危及生命。我们分析了接受IFN治疗清除HCV的慢性丙型肝炎患者的长期预后。我们调查了1989年4月至1999年3月期间在我们机构接受IFN治疗的1277例慢性HCV感染患者中的392例持续应答者。我们分析了病历并寻找HCC的发生情况。约30%的持续应答者在IFN治疗结束3年后失访，持续应答者的随访率显著低于非持续应答者（P<0.0001）。在8例患者中发现了HCC：7例患者在完成IFN治疗后5年内发生HCC；但在1例患者中，在完成IFN治疗7至8年后检测到1个直径小于3 cm的单发HCC。在5例接受定期医学随访的患者中，HCC为单发，患者存活且无复发迹象。在3例未接受随访的患者中，2例死于HCC，第3例出现HCC复发。这些结果表明，持续应答者可能发生HCC，持续应答者在完成IFN治疗后应密切随访，以便早期发现HCC。持续应答者的最佳随访期仍不清楚。需要进行更多的前瞻性研究，以便为IFN治疗的持续应答者建立适当的随访方案。
