Iwasaki Yoshiaki, Takaguchi Kouichi, Ikeda Hiroshi, Makino Yasuhiro, Araki Yasuyuki, Ando Masaharu, Kobashi Haruhiko, Kobatake Toshitsugu, Tanaka Ryoji, Tomita Minoru, Senoh Tomonori, Kawaguchi Mitsuhiko, Shimoe Toshinari, Manabe Koji, Kita Keiji, Shimamura Junnosuke, Sakaguchi Kohsaku, Shiratori Yasushi
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Liver Int. 2004 Dec;24(6):603-10. doi: 10.1111/j.1478-3231.2004.0956.x.
Although a variety of papers demonstrated inhibited hepatocarcinogenesis with interferon (IFN) therapy for chronic hepatitis C, a small number of hepatocellular carcinomas (HCCs) were still observed even in sustained virologic responders.
To clarify factors affecting the development of HCC, we analyzed the frequency of HCC in sustained virologic responders over a long-term observation period.
Seven hundred and ninety-two out of the 2623 IFN-treated hepatitis C patients who had undergone liver biopsy showed sustained virologic response. Screening for development of HCC was performed periodically during an average follow-up of 5.1 years. Fibrosis of the pretreatment liver biopsy sample was graded. Risk factors for HCC were analyzed by using Cox proportional hazards regression.
Of 792 patients, 23 developed HCC. Univariate analysis showed that stage of hepatic fibrosis, age, and alcohol consumption were significantly associated with a risk of HCC (P<0.001). There was a significant difference in the cumulative incidence between patients stratified according to these variables (P<0.001).
Pretreatment hepatic fibrosis score, age, and alcohol consumption may affect development of HCC even in sustained virologic responders. Thus, patients with these factors should be carefully followed even after eradication of the virus.
尽管多篇论文表明，干扰素（IFN）治疗慢性丙型肝炎可抑制肝癌发生，但即使在病毒学持续应答者中仍观察到少数肝细胞癌（HCC）病例。
为阐明影响HCC发生的因素，我们在长期观察期内分析了病毒学持续应答者中HCC的发生频率。
2623例接受IFN治疗的丙型肝炎患者中，792例接受了肝活检并表现出病毒学持续应答。在平均5.1年的随访期间定期筛查HCC的发生情况。对治疗前肝活检样本的纤维化程度进行分级。采用Cox比例风险回归分析HCC的危险因素。
792例患者中，23例发生HCC。单因素分析显示，肝纤维化分期、年龄和饮酒与HCC风险显著相关（P<0.001）。根据这些变量分层的患者之间累积发病率存在显著差异（P<0.001）。
即使在病毒学持续应答者中，治疗前肝纤维化评分、年龄和饮酒也可能影响HCC的发生。因此，即使在病毒清除后，有这些因素的患者也应密切随访。
