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Normalization of ALT in HCV Patients with Cirrhosis Significantly Reduces the Risk of Hepatocellular Carcinoma
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There have been several retrospective cohort studies on the inhibition of
hepatocellular carcinoma (HCC) development in chronic hepatitis C (CH-C)
patients. However, a definitive analysis from a prospective study is not yet
available.
Japanese researchers undertook a prospective study of interferon therapy for chronic hepatitis C patients with cirrhosis to elucidate the role of
antiviral therapy for inhibition of HCC with long-term observation of 5 years
as a second end-point of prior prospective antiviral studies (Shiratori Y et
al. Hepatology 1999, Liver 2000).
300 patients (238 for the treatment group and 62 for control) were registered in this prospective study. Patients received regular medical check-up using blood tests and abdominal ultrasonography to detect HCC every 3-6 months. The effect of antiviral therapy on inhibition of HCC development was analyzed with Cox proportional hazard model and a time dependent covariate analysis.
HCC was detected in 74 patients during 5-year follow-up; 56 (23%) from the
238 interferon-treated patients and 18 (29%) from the 62 untreated patients.
Of the 53 and 185 patients with sustained virological response (SVR) and
non-sustained response (Non-SVR), HCC developed in 7 (13%) and 49 (27%),
respectively.
The cumulative incidence of HCC in interferon-treated patients was slightly
lower than that in untreated patients. However, when the patients were
stratified according to SVR, cumulative HCC incidence among the SVR patients was lower as compared with the Non-SVR and untreated patients.
Of the clinical parameters, SVR to interferon was the strongest factor for
inhibition of HCC development. Time dependent covariate analysis revealed
that the risk ratio of interferon therapy for HCC development was only 0.889,
but negativity of HCV RNA and normalization of serum ALT related to an
inhibition of HCC with marginal significance. More importantly, sustained
normalization of ALT in patients with Non-SVR was related to an inhibition of
HCC development (RR=0.23, 95%CI: 0.05-0.99, p=0.049).
Conclusion: Sustained normalization of serum ALT in cirrhotic patients even
without sustained virological response from antiviral therapy significantly
reduced the risk of HCC development.
Y Shiratori and others. LONG-TERM PROSPECTIVE STUDY OF ANTIVIRAL THERAPY ON REDUCED DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS C PATIENTS WITH CIRRHOSIS. Abstract 774. 53rd AASLD. Nov 2002,
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