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- Title
Antiviral therapy for cirrhotic hepatitis C: association with reduced hepatocellular carcinoma development and improved survival.
- Authors
Shiratori, Yasushi; Ito, Yoichi; Yokosuka, Osamu; Imazeki, Fumio; Nakata, Ryo; Tanaka, Naohide; Arakawa, Yasuyuki; Hashimoto, Etsuko; Hirota, Katsutaro; Yoshida, Haruhiko; Ohashi, Yasuo; Omata, Masao; Tokyo-Chiba Hepatitis Research Group
- Abstract
<bold>Background: </bold>Although cirrhosis is a major risk factor for development of hepatocellular carcinoma, no definitive prospective analyses have assessed the long-term efficacy of antiviral therapy in cirrhotic patients.<bold>Objective: </bold>To elucidate the role of antiviral therapy in the suppression of liver tumors and survival over a long-term follow-up period.<bold>Design: </bold>Prospective cohort study.<bold>Setting: </bold>25 clinical centers.<bold>Patients: </bold>345 patients with chronic hepatitis C and cirrhosis enrolled in previous trials.<bold>Intervention: </bold>271 patients received 6 to 9 million U of interferon 3 times weekly for 26 to 88 weeks; 74 received no treatment.<bold>Measurements: </bold>Blood tests and abdominal ultrasonography were done regularly to detect hepatocellular carcinoma.<bold>Results: </bold>Hepatocellular carcinoma was detected in 119 patients during a 6.8-year follow-up: 84 (31%) in the interferon-treated group and 35 (47%) in the untreated group. Cumulative incidence of hepatocellular carcinoma among interferon-treated patients was significantly lower than in untreated patients (Cox model: age-adjusted hazard ratio, 0.65 [95% CI, 0.43 to 0.97]; P = 0.03), especially sustained virologic responders. A total of 69 patients died during follow-up: 45 (17%) in the treated group and 24 (32%) in the untreated group. Interferon-treated patients had a better chance of survival than the untreated group (Cox model: age-adjusted hazard ratio, 0.54 [CI, 0.33 to 0.89]; P = 0.02). This was especially evident in sustained virologic responders.<bold>Limitation: </bold>This was not a randomized, controlled study. Patients enrolled in the control group had declined to receive interferon treatment even though they were eligible for treatment.<bold>Conclusion: </bold>Interferon therapy for cirrhotic patients with chronic hepatitis C, especially those in whom the infection had been cured, inhibited the development of hepatocellular carcinoma and improved survival.
- Subjects
CIRRHOSIS of the liver; LIVER cancer; PATIENTS; ANTIVIRAL agents; INTERFERONS; ULTRASONIC imaging
- Publication
Annals of Internal Medicine, 2005, Vol 142, Issue 2, p105
- ISSN
0003-4819
- Publication type
journal article