Akamatsu Masatoshi, Yoshida Haruhiko, Shiina Shuichiro, Teratani Takuma, Obi Shuntaro, Tateishi Ryousuke, Mine Norio, Kondo Yuji, Kawabe Takao, Omata Masao
Department of Gastroenterology, The University of Tokyo Hospital, Tokyo, Japan.
Liver Int. 2006 Jun;26(5):536-42. doi: 10.1111/j.1478-3231.2006.01260.x.
We conducted this retrospective study to evaluate the position of interferon therapy in the curative treatment of hepatitis C virus-associated hepatocellular carcinoma (HCC).
We compared overall and recurrence-free survival rates between 191 patients who received interferon therapy before HCC development (15 with sustained virologic response (SVR)), 53 who received interferon therapy after HCC ablation (17 with SVR), and 399 HCC patients with Child-Pugh class A liver function who did not receive interferon (controls).
The overall survival rate in the controls was 82.4%, 53.2%, and 28.3% at 3, 6, and 9 years, respectively, whereas that in patients who developed HCC after achieving SVR was 93.3%, 93.3%, and 93.3%; those with HCC after non-SVR, 87.8%, 56.5%, and 35.8%; SVR after HCC, 100%, 87.5%, and 59.7%; and non-SVR after HCC, 94.3%, 70.9%, and 53.2%. Cox proportional hazard regression analysis revealed that the risk of death was significantly reduced in patients with HCC after SVR and those with SVR after HCC, with a risk ratio of 0.124 (95% confidence interval (95% CI): 0.017-0.890, P = 0.0378) and 0.388 (95% CI: 0.169-0.887, P = 0.0250), respectively, compared with the controls. Improved survival was attributable mainly to sustained liver function among patients with SVR, and recurrence-free survival did not differ significantly.
Interferon therapies before and after HCC development were both significantly associated with prolonged survival when SVR was achieved.
我们开展这项回顾性研究以评估干扰素治疗在丙型肝炎病毒相关性肝细胞癌（HCC）根治性治疗中的地位。
我们比较了191例在HCC发生前接受干扰素治疗的患者（15例获得持续病毒学应答（SVR））、53例在HCC消融后接受干扰素治疗的患者（17例获得SVR）以及399例未接受干扰素治疗的Child-Pugh A级肝功能的HCC患者（对照组）的总生存率和无复发生存率。
对照组在3年、6年和9年时的总生存率分别为82.4%、53.2%和28.3%，而在获得SVR后发生HCC的患者中分别为93.3%、93.3%和93.3%；未获得SVR后发生HCC的患者中分别为87.8%、56.5%和35.8%；HCC后获得SVR的患者中分别为100%、87.5%和59.7%；HCC后未获得SVR的患者中分别为94.3%、70.9%和53.2%。Cox比例风险回归分析显示，与对照组相比，SVR后发生HCC的患者以及HCC后获得SVR的患者死亡风险显著降低，风险比分别为0.124（95%置信区间（95%CI）：0.017 - 0.890，P = 0.0378）和0.388（95%CI：0.169 - 0.887，P = 0.0250）。生存改善主要归因于SVR患者的肝功能持续稳定，且无复发生存率无显著差异。
当获得SVR时，HCC发生前后的干扰素治疗均与生存期延长显著相关。
