Detection of hepatocellular carcinoma after interferon therapy for chronic hepatitis C: Clinical study of 26 cases

Abstract

The clinical findings in 26 patients in whom hepatocellular carcinoma (HCC) was detected after the start of interferon (IFN) therapy for chronic hepatitis C were analysed. Histological study before IFN therapy showed that 34.6% of patients were categorized as stage 3 (septal fibrosis with architectural distortion; the 0-4 scale) and 80.8% demonstrated at least some evidence of septal fibrosis or more advanced features. The AFP levels examined before IFN therapy were more than 20 ng/mL in 13 patients (84.6% of those studied). One of 26 patients had a complete response to IFN therapy, while six of 26 patients had only a partial response. HCC was detected within 1 year after the start of IFN therapy in 76.9% of patients. Thus, the possibility of the early occurrence of HCC or its existence at the time of therapy should be seriously considered when IFN therapy is contemplated. Patients with stage 3 or 3-4 histology may already have a small undetectable HCC before IFN therapy. Thus, for this reason, every patient treated with IFN should be examined at short regular intervals for the development of HCC during and after IFN therapy.

Occurrence of Hepatocellular Carcinoma Was Not a Rare Event during and Immediately after Antiviral Treatment in Japanese HCV-Positive Patients

“…There have been several reports regarding HCC developing even many years after complete HCV eradication [13,27]. Our results support the previous findings that every patient treated with IFN should be examined at regular short intervals for the development of HCC both during and after IFN therapy [25], although further studies will be needed to determine the manner of examination.…”

“…Sugiura et al [25] reported that the possibility of the early occurrence of HCC or its existence at the time of therapy should be seriously considered when IFN therapy is contemplated, and that patients with stage 3 or 3–4 histology may already have a small undetectable HCC before IFN therapy. In the near future, we will use direct-acting antiviral agents (DAAs) with and later without IFN [4,26], and then we will be able to treat much older patients infected with HCV, or HCV-positive patients with advanced liver disease.…”

Influence of Previous Interferon Therapy on Recurrence after Resection of Hepatitis C Virus‐related Hepatocellular Carcinoma

“…[6][7][8][9][10][11][12][13][14] We have reported that continuous active hepatitis with HCV viremia is a high risk factor for recurrence after the resection of HCV-related HCC and that the results after liver resection for HCC in patients with anti-HCV antibody (anti-HCV) and without HCV viremia were satisfactory. 15) However, the influence of previous IFN therapy on the patient's outcome after the resection of HCV-related HCC has not been evaluated.…”

“…[2][3][4] Since we reported that IFN decreases the incidence of HCC in patients with chronic hepatitis C and cirrhosis in a prospective randomized study, 5) several investigators have shown that IFN suppresses the incidence of HCC in patients with chronic hepatitis C. [6][7][8][9][10][11][12][13] However, HCCs are found even in some patients successfully treated with IFN. [6][7][8][9][10][11][12][13][14] We have reported that continuous active hepatitis with HCV viremia is a high risk factor for recurrence after the resection of HCV-related HCC and that the results after liver resection for HCC in patients with anti-HCV antibody (anti-HCV) and without HCV viremia were satisfactory. 15) However, the influence of previous IFN therapy on the patient's outcome after the resection of HCV-related HCC has not been evaluated.…”

Development of hepatocellular carcinoma after sustained response to interferon therapy: how long should sustained responders with risk factors be followed?

“…[12][13][14][15][16][17][18] Although a significant decrease in the incidence of HCC has been observed in patients with sustained response, HCC is detected in some of them. [19][20][21][22][23][24][25][26][27][28][29][30][31][32] The clinical features of sustained responders who develop HCC and the long-term incidence of HCC in those patients remain unclear, and the optimal duration and frequency of follow-up have not been established. Recently, Makiyama et al reported 27 patients (2.3%) of 1197 sustained responders developed HCC during a mean follow-up of 5.9 years.…”