The long-term pathological evolution of chronic hepatitis C.
Most patients infected with hepatitis C virus (HCV) develop chronic hepatitis. Unfortunately, the pathological evolution of this disease over time is not completely understood. We studied 70 HCV-positive patients, from whom 2 to 10 liver biopsy specimens (mean, 3.9) had been obtained during an interval of 1 to 26 years (mean, 8.8 years). Each biopsy specimen was evaluated independently by four pathologists who each provided a numerical score for the grade of portal/periportal necroinflammation (0-4), grade of lobular necroinflammation (0-4), their sum (final grade), and the stage of fibrosis (1-4). The scores were correlated with progression of disease, if any, and transition to cirrhosis. During follow-up, 35 patients (50%) developed cirrhosis. Cirrhosis developed in all patients with a high final grade (> or = 5) of necroinflammation on initial biopsy who were followed for 10 years and in 96% of patients with an intermediate final grade (3.5-4.9) who were followed for 17 years. Only 30.4% of patients with low final grade (< or = 3.4) on initial biopsy developed cirrhosis after 13 years. All patients with evidence of septal fibrosis with incomplete nodularity (stage 3.0-3.4) in the initial biopsy progressed to unequivocal cirrhosis by 10 years. The rate of progression to cirrhosis was accelerated in patients whose initial biopsies showed high-grade and -stage lesions. This study demonstrates the importance of grading and staging liver biopsy lesions in chronic hepatitis C, particularly for patients with high-grade necroinflammation, septal fibrosis, and regions of modularity on initial biopsy who are at high risk of developing advanced cirrhosis in the ensuing decade.
Yano
M
M
Nagasaki Chuo National Institute for Clinical Research, Ohmura-shi, Japan.
Kumada
H
H
Kage
M
M
Ikeda
K
K
Shimamatsu
K
K
Inoue
O
O
Hashimoto
E
E
Lefkowitch
J H
JH
Ludwig
J
J
Okuda
K
K
D001706:Biopsy; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000209:etiology / Q000473:pathology*; D006521:Hepatitis, Chronic / Q000150:complications / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology; D008297:Male; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors