Dohmen Kazufumi, Kawano Akira, Takahashi Kazuhiro, Shigematsu Hirohisa, Tanaka Hirofumi, Haruno Masatora, Yanagita Kimihoko, Ichiki Yasunori, Mori Tetsu, Hayashida Kazuhiro, Shimoda Shinji, Ishibashi Hiromi, Nomura Hideyuki
Hepatogastroenterology. 2013 Nov-Dec;60(128):2034-8.
BACKGROUND/AIMS: Although the incidence of hepatocellular carcinoma (HCC) has been shown to be reduced after pegylated glycol-interferon plus ribavirin (Peg-IFN/RBV) therapy in patients with chronic hepatitis C, the risk factors for the development of HCC are not fully understood. The aim of this study was to clarify the incidence and the risk factors for the development of HCC after Peg-IFN/RBV therapy in patients with chronic hepatitis C.
A total of 474 patients with chronic hepatitis C who received Peg-IFN/RBV therapy between December 2004 and August 2010 were enrolled and followed in a multicenter trial. The patients were assessed for HCC by either ultrasound or computed tomography every 6 months. The incidence and risk factors for the development of HCC were identified.
Of the 474 patients, 23 developed HCC during a median follow-up of 4 years and 8 months (range 1-6 years and 3 months) after completion of Peg-IFN/RBV therapy. According to a univariate analysis, higher age, low platelet counts, a low level of serum albumin, a high level of alpha-fetoprotein (AFP) and a sustained viral response (SVR) to Peg-IFN/RBV therapy were independent factors associated with the occurrence of HCC. The multivariate analysis using the Cox proportional hazard model revealed the risk factors for HCC were the platelet count, AFP level and the outcome of Peg-IFN/RBV therapy.
To reduce the incidence of HCC in chronic hepatitis C, attainment of a sustained response rate is an essential issue. For patients with low platelet counts and/or a high AFP level, strict surveillance should be continued even after eradication of HCV because the risk of HCC was found to be higher for these patients.
背景/目的：尽管已显示聚乙二醇化干扰素联合利巴韦林（Peg-IFN/RBV）治疗慢性丙型肝炎患者后肝细胞癌（HCC）的发病率有所降低，但HCC发生的危险因素尚未完全明确。本研究的目的是阐明慢性丙型肝炎患者接受Peg-IFN/RBV治疗后HCC的发生率及危险因素。
共有474例在2004年12月至2010年8月期间接受Peg-IFN/RBV治疗的慢性丙型肝炎患者纳入一项多中心试验并进行随访。每6个月通过超声或计算机断层扫描对患者进行HCC评估。确定HCC发生的发生率及危险因素。
在474例患者中，23例在完成Peg-IFN/RBV治疗后的中位随访时间4年8个月（范围1 - 6年3个月）内发生了HCC。单因素分析显示，年龄较大、血小板计数低、血清白蛋白水平低、甲胎蛋白（AFP）水平高以及对Peg-IFN/RBV治疗的持续病毒学应答（SVR）是与HCC发生相关的独立因素。使用Cox比例风险模型进行的多因素分析显示，HCC的危险因素为血小板计数、AFP水平及Peg-IFN/RBV治疗的结果。
为降低慢性丙型肝炎患者中HCC的发生率，实现持续应答率是一个关键问题。对于血小板计数低和/或AFP水平高的患者，即使在HCV根除后仍应继续严格监测，因为发现这些患者发生HCC的风险更高。
