Antiviral therapy for cirrhotic hepatitis C: Association with reduced hepatocellular carcinoma development and improved survival
Antiviral therapy for cirrhotic hepatitis C: Association with reduced hepatocellular carcinoma development and improved survival
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DOI：
10.7326/0003-4819-142-2-200501180-00009
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发表时间：
2005-01-18
影响因子：
39.2
通讯作者：
Omata, M
中科院分区：
文献类型：
--
作者：
Shiratori, Y;Ito, Y;Omata, M
背景资料：虽然肝硬化是发展为肝细胞癌的主要危险因素，但尚无明确的前瞻性分析评估抗病毒治疗在肝硬化患者中的长期疗效。目的：阐明抗病毒治疗在抑制肝肿瘤和长期随访期生存中的作用。设计：前瞻性队列研究。设置：25个临床中心。患者：345例慢性丙型肝炎和肝硬化患者参加了先前的试验。干预：271例患者接受每周3次600万至900万U的干扰素治疗，持续26至88周; 74例未接受治疗。测量：定期进行血液检查和腹部超声检查以检测肝细胞癌。结果：在6.8年的随访中，119例患者检测到肝细胞癌：干扰素治疗组84例（31%），未治疗组35例（47%）。干扰素治疗患者中肝细胞癌的累积发病率显著低于未治疗患者（考克斯模型：年龄校正风险比，0.65 [95%CI，0.43 - 0.97]; P = 0.03），尤其是持续病毒学应答者。随访期间共有69例患者死亡：治疗组45例（17%），未治疗组24例（32%）。干扰素治疗组的生存率高于未治疗组（考克斯模型：年龄校正风险比，0.54 [CI，0.33 - 0.89]; P = 0.02）。这在持续的病毒学应答者中尤其明显。局限性：这不是一项随机对照研究。在对照组的患者已拒绝接受干扰素治疗，即使他们有资格treatment.Conclusion：干扰素治疗慢性丙型肝炎患者，特别是那些感染已治愈，抑制肝细胞癌的发展，提高生存。
Background: 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.Objective: To elucidate the role of antiviral therapy in the suppression of liver tumors and survival over a long-term follow-up period.Design: Prospective cohort study.Setting: 25 clinical centers.Patients: 345 patients with chronic hepatitis C and cirrhosis enrolled in previous trials.Intervention: 271 patients received 6 to 9 million U of interferon 3 times weekly for 26 to 88 weeks; 74 received no treatment.Measurements: Blood tests and abdominal ultrasonography were done regularly to detect hepatocellular carcinoma.Results: 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% Cl, 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 [Cl, 0.33 to 0.89]; P = 0.02). This was especially evident in sustained virologic responders.Limitation: 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.Conclusion: 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.