title: Antiviral therapy for cirrhotic hepatitis C: association with reduced hepatocellular carcinoma development and improved survival.
abstract: BACKGROUND
  Although cirrhosis is a major risk factor for development of hepatocellular carcinoma, no definitive prospective analyses have assessed the long-term efficacy of antiviral therapy in cirrhotic patients.
  
  
  OBJECTIVE
  To elucidate the role of antiviral therapy in the suppression of liver tumors and survival over a long-term follow-up period.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  25 clinical centers.
  
  
  METHODS
  345 patients with chronic hepatitis C and cirrhosis enrolled in previous trials.
  
  
  METHODS
  271 patients received 6 to 9 million U of interferon 3 times weekly for 26 to 88 weeks; 74 received no treatment.
  
  
  METHODS
  Blood tests and abdominal ultrasonography were done regularly to detect hepatocellular carcinoma.
  
  
  RESULTS
  Hepatocellular carcinoma was detected in 119 patients during a 6.8-year follow-up: 84 (31%) in the interferon-treated group and 35 (47%) in the untreated group. Cumulative incidence of hepatocellular carcinoma among interferon-treated patients was significantly lower than in untreated patients (Cox model: age-adjusted hazard ratio, 0.65 [95% CI, 0.43 to 0.97]; P = 0.03), especially sustained virologic responders. A total of 69 patients died during follow-up: 45 (17%) in the treated group and 24 (32%) in the untreated group. Interferon-treated patients had a better chance of survival than the untreated group (Cox model: age-adjusted hazard ratio, 0.54 [CI, 0.33 to 0.89]; P = 0.02). This was especially evident in sustained virologic responders.
  
  
  CONCLUSIONS
  This was not a randomized, controlled study. Patients enrolled in the control group had declined to receive interferon treatment even though they were eligible for treatment.
  
  
  CONCLUSIONS
  Interferon therapy for cirrhotic patients with chronic hepatitis C, especially those in whom the infection had been cured, inhibited the development of hepatocellular carcinoma and improved survival.
authors.affiliation: University of Tokyo, Japanese Red Cross Medical Center, Nippon University School of Medicine, and Tokyo Women's Medical College. shirato@cc.okayama-u.ac.jp <shirato@cc.okayama-u.ac.jp>
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ito
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
authors.forename: Fumio
authors.initials: F
authors.lastname: Imazeki
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakata
authors.forename: Naohide
authors.initials: N
authors.lastname: Tanaka
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Arakawa
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
authors.forename: Katsutaro
authors.initials: K
authors.lastname: Hirota
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D008113:Liver Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D012307:Risk Factors; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins