Ikeda Kenji, Kobayashi Masahiro, Saitoh Satoshi, Someya Takashi, Hosaka Tetsuya, Akuta Norio, Suzuki Fumitaka, Tsubota Akihito, Suzuki Yoshiyuki, Arase Yasuji, Kumada Hiromitsu
Department of Gastroenterology, Toranomon Hospital, and Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Oncology. 2003;65(3):204-10. doi: 10.1159/000074472.
Although hepatocellular carcinoma does develop after sustained response to interferon (IFN) in patients with chronic hepatitis C, details on the clinical prognosis have not been elucidated yet.
Among 12 patients with liver cancer arising after hepatitis C virus (HCV) elimination, 10 patients with potentially curative ablation were prospectively analyzed. Matched control patients were chosen from a patient list of surgical resection on the basis of age, sex, cancer stage, and severity of liver disease. Control patients were recruited with a ratio of 1:4, and all the control patients had positive HCV-RNA.
One (10.0%) of 10 patients with virus elimination and 31 (77.5%) of 40 control patients eventually developed cancer recurrence during the same follow-up period. Cancer recurrence rates of the 10 cases and 40 controls were 10.0 and 55.3% at the 3rd year, and 10.0 and 72.2% at the 5th year, respectively. The recurrence rate in the 10 cases of virus elimination was significantly lower than that of control patients (p = 0.012).
Although hepatocellular carcinogenesis after elimination of HCV-RNA by IFN treatment did rarely occur, the recurrence rate after radical therapy was significantly lower than that of untreated or non-responsive patients.
尽管慢性丙型肝炎患者在对干扰素(IFN)产生持续应答后确实会发生肝细胞癌,但临床预后的详细情况尚未阐明。
在12例丙型肝炎病毒(HCV)清除后发生肝癌的患者中,对10例有可能进行根治性消融的患者进行了前瞻性分析。根据年龄、性别、癌症分期和肝病严重程度,从手术切除患者名单中选取匹配的对照患者。对照患者按1:4的比例招募,所有对照患者的HCV-RNA均为阳性。
在同一随访期内,10例病毒清除患者中有1例(10.0%)最终发生癌症复发,40例对照患者中有31例(77.5%)最终发生癌症复发。10例患者和40例对照患者在第3年的癌症复发率分别为10.0%和55.3%,在第5年分别为10.0%和72.2%。10例病毒清除患者的复发率显著低于对照患者(p = 0.012)。
尽管IFN治疗清除HCV-RNA后很少发生肝细胞癌,但根治性治疗后的复发率显著低于未治疗或无应答患者。