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

Abstract

Interferon (IFN) therapy decreases the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV). One hundred and fifty-nine consecutive patients who underwent liver resection for HCV-related HCC were studied. In 17 (group 1) of the 159 patients, HCC was detected during or after IFN therapy. The incidences of recurrence after surgery in the group 1 patients and the other 142 patients (group 2) were compared. Eight patients had a complete response to IFN, 4 had a partial response, and 5 had no response. The proportion of patients without HCV viremia was significantly higher in the group 1 patients (P < < < <0.0001). The tumor-free survival rate was significantly higher in the group 1 patients (P = = = =0.0010). By multivariate analysis of various risk factors for recurrence, no previous IFN was a significant independent risk factor for recurrence (risk ratio = = = =6.336; 95%CI, 1.512-26.50). The patients with HCC who underwent IFN therapy previously are good candidates for liver resection because recurrence after the operation was rarely observed. Key words: Hepatocellular carcinoma -Hepatitis C virus -Interferon -Liver resection -Multicentric carcinogenesisHepatitis C virus (HCV) infection has been reported to be a cause of hepatocellular carcinoma (HCC). After the report by Hoofnagle et al.1) on the use of interferon (IFN) in chronic hepatitis C, there have been numerous studies suggesting that IFN is effective in the treatment of chronic hepatitis C. Recent studies have shown that IFN causes HCV RNA to disappear not only from the serum, but also from hepatic tissue, and that IFN improves liver histology.2-4) 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. It is not practicable to carry out a randomized prospective study of preoperative IFN (after the detection of HCC) because the therapy takes several months to 1 year to complete and therefore HCC may progress during treatment. In this retrospective study, we tried to determine whether previous IFN therapy improves the tumor-free survival rate after the resection of HCV-related HCC. PATIENTS AND METHODSPatients Between 1993 and December 1999, 178 consecutive patients with anti-HCV (lacking hepatitis B surface antigen) had a curative resection for HCC. Curative surgery was def...

Long-Term Interferon Maintenance Therapy Improves Survival in Patients with HCV-Related Hepatocellular Carcinoma after Curative Radiofrequency Ablation

“…The strategy used to suppress multicentric recurrence has mainly focused on antiviral treatment, immunoregulation, or anti-inflammatory treatment [14,15,16,17,18,19,20]. In our study, HCC recurrence rates did not depend on serum ALT level in the IFN maintenance and control groups.…”

“…Most importantly, in previous studies [16,17,18,19,20, 26, 27] IFN was administered for a short period of time (24–48 weeks). Thus, the inhibitory effect on recurrence that we observed with IFN over a long period of time (maintenance IFN therapy without discontinuation) has not been reported to date.…”

The prognostic significance of clinical and pathological features in hepatocellular carcinoma

“…This result was further confirmed by two pilot RCTs [91,92] . A similar effect was obtained by preoperative IFN-alpha therapy, it might due to IFN can prevent the recurrence of hepatitis B and C virus, and decrease the incidence of HCC in patients with HCV [48,93] . We found high-dose and long-term therapy with IFN-alpha dose-dependently inhibited tumor growth and recurrence after resection of HCC.…”

Adjuvant Therapy after Curative Resection for Hepatocellular Carcinoma Associated with Hepatitis Virus

“…Recently, the number of patients undergoing liver resection for HCC detected after IFN therapy has increased with the number of patients undergoing IFN therapy [34,35] . We evaluated the tumor-free and cumulative survival rates for patients who underwent IFN therapy before and/or after curative resection of HCV-related HCC [36] .…”