Risk factors for development of hepatocellular carcinoma in patients with chronic hepatitis C after sustained response to interferon
Risk factors for development of hepatocellular carcinoma in patients with chronic hepatitis C after sustained response to interferon
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DOI：
10.1007/s00535-004-1519-2
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发表时间：
2005-02-01
影响因子：
6.3
通讯作者：
Watanabe, H
中科院分区：
文献类型：
--
作者：
Ikeda, M;Fujiyama, S;Watanabe, H
背景干扰素（IFN）有望阻止丙型肝炎病毒感染进展为肝硬化和肝细胞癌（HCC）的发展，但已有几份报告显示，对IFN持续应答后发生HCC。我们的目的是阐明慢性丙型肝炎IFN持续应答者中HCC的发病率、临床特征和危险因素。方法.我们设计了一项在16家主要医院进行的回顾性队列研究。受试者共1056例患者显示持续缓解，其中29例发生HCC。结果在持续应答者中，每100人-年的HCC发病率为0.56（95%置信区间，0.35-0.76）。通过考克斯比例风险模型，我们发现年龄大，血清天冬氨酸转氨酶水平高，IFN治疗前血小板计数低是肝癌发生的独立危险因素。根据这些危险因素的系数，HCC发展的危险指数被用于将患者分为三组，低，中和高风险。这三组的HCC发病率分别为0.11、0.44和1.98/100人-年。发生HCC的中位时间为4.6年（范围：1.4-9.0年），并且在这些患者中没有发生HCC的其他特定临床特征。结论.这项研究表明，肝癌的发展风险并没有完全消除持续响应IFN。这些发现可能是有用的，在确定一个后续战略后，持续响应IFN。
Background. Interferon (IFN) is expected to prevent the progression of hepatitis C virus infection to cirrhosis and the development of hepatocellular carcinoma (HCC), but there have been several reports of the development of HCC after a sustained response to IFN. Our aim was to elucidate the incidence and clinical features of, and risk factors for, HCC in sustained responders to IFN, taken for the treatment of chronic hepatitis C. Methods. We designed a retrospective cohort study conducted at 16 major Hospitals. The subjects were a total of 1056 patients showing sustained responses, 29 of whom developed HCC. Results. The incidence of HCC per 100 person-years was 0.56 (95% confidence interval, 0.35-0.76) in sustained responders. By the Cox proportional hazard model, we found that older age, higher serum aspartate aminotransferase level, and lower platelet count before IFN therapy were independent risk factors associated with the development of HCC. A risk index of HCC development, based on the coefficients of these risk factors, was used to classify patients into three groups, with low, intermediate, and high risk. The incidence rates of HCC for these three groups were 0.11, 0.44, and 1.98 per 100 person-years, respectively. The median period to the development of HCC was 4.6 years (range, 1.4-9.0 years), and there were no other specific clinical features of the HCC that developed in these patients. Conclusions. This study suggests that the risk of development of HCC is not completely eliminated in sustained responders to IFN. These findings may be useful in determining a follow-up strategy after a sustained response to IFN.