尽管干扰素诱导的持续病毒学应答，肝硬化患者仍有发生肝细胞癌的风险。

Cirrhotic patients are still at risk of developing hepatocellular carcinoma despite Interferon-induced sustained virological response.

机构信息

Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Italy.

出版信息

Eur Rev Med Pharmacol Sci. 2014 Dec;18(2 Suppl):11-5.

Abstract

INTRODUCTION

Hepatitis C virus (HCV) infection is a common cause of chronic liver disease and hepatocellular carcinoma (HCC). The prevalence of HCC significantly declines among patients achieving a sustained virological response (SVR) after antiviral therapy with pegylated(PEG)-interferon (IFN) and ribavirin. However, up to 5% of patients with SVR may develop HCC.

PATIENTS AND METHODS

We investigated the epidemiological, clinical, biochemical and virological characteristics of a small cohort of patients with chronic hepatitis C (CHC) who developed HCC after being successfully treated with PEG-IFN-α and ribavirin.

RESULTS

Between September 2000 and January 2003, 598 patients with CHC underwent a complete course of treatment with PEG-IFN-α and ribavirin; 221 out of 598 (37%) patients obtained a SVR. Throughout the 10-year post-treatment follow up, 13 of 221 ( 5.8% ) SVR patients developed HCC. All 13 patients were male and were affected with Child A liver cirrhosis; in addition, at baseline they were significantly older (p < 0.05) and had higher alpha-fetoprotein levels (p < 0.05) in comparison with those who did not develop HCC. Nine patients (69.3%) developed HCC within the first 3 years after antiviral treatment completion, one patient (7.7%) between 3 and 5 years and 3 subjects (23%) between 5 and 10 years; 12 of 13 had a solitary lesion with a mean diameter of 2.5± 0.5 cm. Eleven cases (84.6%) underwent surgical resection, one (7.7%) received liver transplantation, one (7.7%) received palliative care.

CONCLUSIONS

The risk of developing HCC after achieving SVR persists in patients with HCV-related cirrhosis. As a consequence, these patients should continue to undergo long-term surveillance for HCC, in order to early detect and treat it.

摘要

简介

丙型肝炎病毒（HCV）感染是慢性肝病和肝细胞癌（HCC）的常见病因。在接受聚乙二醇（PEG）-干扰素（IFN）和利巴韦林抗病毒治疗后达到持续病毒学应答（SVR）的患者中，HCC 的患病率显著下降。然而，多达 5%的 SVR 患者可能会发展为 HCC。

患者和方法

我们研究了一小部分成功接受 PEG-IFN-α和利巴韦林治疗的慢性丙型肝炎（CHC）患者的流行病学、临床、生化和病毒学特征，这些患者在治疗后发展为 HCC。

结果

在 2000 年 9 月至 2003 年 1 月期间，598 例 CHC 患者接受了完整的 PEG-IFN-α和利巴韦林治疗；598 例患者中有 221 例（37%）获得 SVR。在治疗后 10 年的随访中，221 例 SVR 患者中有 13 例（5.8%）发展为 HCC。所有 13 例患者均为男性，患有 A 级肝硬化；此外，与未发生 HCC 的患者相比，他们在基线时年龄明显更大（p < 0.05），甲胎蛋白水平更高（p < 0.05）。9 例（69.3%）患者在抗病毒治疗结束后 3 年内发生 HCC，1 例（7.7%）患者在 3 至 5 年内，3 例（23%）患者在 5 至 10 年内；13 例患者中有 12 例为单发病变，平均直径为 2.5±0.5cm。11 例（84.6%）患者接受了手术切除，1 例（7.7%）患者接受了肝移植，1 例（7.7%）患者接受了姑息治疗。