Arase Yasuji, Ikeda Kenji, Suzuki Fumitaka, Suzuki Yoshiyuki, Saitoh Satoshi, Kobayashi Masahiro, Akuta Norio, Someya Takashi, Koyama Rikako, Hosaka Tetsuya, Sezaki Hitomi, Kobayashi Mariko, Kumada Hiromitsu
Department of Gastroenterology, and Hepatic Research Unit, Toranomon Hospital, Toranomon, Tokyo, Japan.
Intervirology. 2007;50(1):16-23. doi: 10.1159/000096308.
The purpose of this study was to elucidate the long-term outcome after interferon (IFN) therapy in chronic hepatitis C elderly patients.
We studied the incidence of hepatocellular carcinoma (HCC) and survival probability after the initiation of IFN therapy in 500 Japanese chronic hepatitis C patients >60 years. The mean age of initiation of IFN was 63 years and the mean follow-up period was 7.4 years. Cox proportional hazard regression analysis was used to evaluate the long-term outcome after initiation of IFN therapy. Sustained virological response (SVR) was defined as negative HCV-RNA by RT-nested PCR 6 months after the completion of long-term IFN therapy. Non-response (NR) was applied to patients who did not show SVR. Hepatic fibrosis was defined as the fibrosis score (score 0-4) according to Knodell et al.
140 patients (28%) had an SVR and 360 patients (72%) had an NR. 71 of 500 patients developed HCC during follow-up. The cumulative incidence of HCC was 9.6% at the 5th year, 17.4% at the 10th year, and 31.3% at the 15th year. HCC developed with significance when: (1) HCV was not cleared after IFN therapy (p < 0.0001), (2) sex was male (p < 0.0001), and (3) staging of liver fibrosis was >2 (p = 0.008). 53 of the patients died. The cumulative survival probability was 95.7% at the 5th year, 86.4% at the 10th year, and 78% at the 15th year. Patients achieved a long survival with significance when: (1) staging of liver fibrosis was 1 (p < 0.0001), (2) HCV was cleared after IFN therapy (p = 0.034), and (3) sex was female (p = 0.015).
Chronic hepatitis C patients with clearance of HCV after IFN therapy had a significantly reduced risk of HCC appearance and achieved prolonged survival even if they are > or =60 years.
本研究旨在阐明慢性丙型肝炎老年患者接受干扰素（IFN）治疗后的长期预后情况。
我们研究了500名年龄大于60岁的日本慢性丙型肝炎患者在开始IFN治疗后肝细胞癌（HCC）的发生率和生存概率。IFN开始治疗时的平均年龄为63岁，平均随访期为7.4年。采用Cox比例风险回归分析来评估IFN治疗开始后的长期预后。持续病毒学应答（SVR）定义为长期IFN治疗结束后6个月通过逆转录巢式PCR检测HCV-RNA为阴性。无应答（NR）适用于未显示SVR的患者。肝纤维化根据Knodell等人的方法定义为纤维化评分（0-4分）。
140例患者（28%）获得SVR，360例患者（72%）为NR。500例患者中有71例在随访期间发生HCC。HCC的累积发生率在第5年为9.6%，第10年为17.4%，第15年为31.3%。在以下情况时HCC发生具有显著性：（1）IFN治疗后HCV未清除（p<0.0001），（2）性别为男性（p<0.0001），（3）肝纤维化分期>2（p=0.008）。53例患者死亡。累积生存概率在第5年为95.7%，第10年为86.4%，第15年为78%。在以下情况时患者获得长期生存具有显著性：（1）肝纤维化分期为1（p<0.0001），（2）IFN治疗后HCV被清除（p=0.034），（3）性别为女性（p=0.015）。
即使年龄≥60岁，IFN治疗后HCV清除的慢性丙型肝炎患者发生HCC的风险显著降低且生存期延长。
Zotero 插件