LONG-TERM PROGNOSIS OF HEPATOCELLULAR CARCINOMA DEVELOPING AFTER INTERFERON TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS B

Author(s): 
L ZHUANG 1, J YOU 2, YL Ll 1, L KONG 1, H LEI 1, HY CHEN 2, L YU 2, BZ TANG 2, ML HUANG 2, YW QIAO 2
1The Third Municipal People's Hospital ofKunming, China, 2The First Affiliated Hospital of Kunming Medical University China
Text: 
BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) is one of the commonest internal malignancies and among the most common causes of cancer deaths worldwide. Recent data from Japan and the USA suggest that the incidence of HCC is rising sharply. The pathogenesis of HCC has been attributed variously to cirrhosis, chronic injury, and direct oncogenic effects of viruses. Although most HCCs arise in cirrhotic livers, a significant number occur in patients without cirrhosis. Hepatitis B virus (HBV) and C virus (HCV) have been considered as the most important causative factors for HCC, especially for in-patients with liver cirrhosis. High liver cell proliferation during chronic hepatitis is associated with an increased risk of liver cancer that may be reduced by interferon (IFN) therapy. JFN-a has antiviral, anti-inflammatory, antiproliferative and anti-carcinogenic action. Recent studies suggest that IFN therapy may decrease the risk of HCC in chronic hepatitis C (CHC). The long-term prognosis of IFN to chronic hepatitis B (CHB) has been confirmed by the improvement of histological findings of liver. The aims of this study were to investigate incidence of HCC in patients with CHB those treated with IFN, and compare the results with that in the developing HCC from the non-IFN treated (NT) group.
METHODS: 158 patients with chronic HBV infection who started IFN therapy (6 months duration) from 1994 were enrolled in this study. The patients in the NT group were 60 patients without treatment of IFN from 1994. All the patients enrolled in this study were histologically proven chronic hepatitis (CH) or child A liver cirrhosis (LC). Presence of HCC was examined every 6-12 months by abdominal US or CT. Efficacy of IFN therapy was categorized as follows. Complete response (CR) was defined as persistent normalization of ALT levels during IFN therapy and follow-up with a sustained serum HBV DNA-negative status. All other response patterns were regarded as non-complete response (NCR).
RESULTS: Median follow-up periods of patients with CR (76 patients), NCR (82 patients) and NT (60 patients) were 8.2, 8.8 and 8.6 years, respectively. During follow-up, of 158 patients treated with IFN, patients developing HCC were a total of 4 patients (2.53%), 2 patients (2.63%) in CR group, 2 (2.44%) in NCR group and 12 patients (20%) in NT group developed HCC. The 5-year rates of HCC incidence were 0%, 0% and 5.0% in the CR group, the NCR group and the NT group, respectively. Cumulative incidences of HCC in the patients with both CR and NCR were significantly lower than that in the patients with NT (vs. NT, x2=10.95, pCONCLUSIONS: The incidence of HCC in patients with CHB after IFN therapy was very low, and the incidences of HCC were lower in the patients with not only CR but also NCR than that in the patients with NT. The result indicates that IFN therapy decreased incidence of HCC in patients with CHB.