Abstract
Background/Aims: The aims of α-interferon treatment for chronic viral liver infections are clearance of the virus and healing of the disease. Hepatocellular carcinoma is a complication of viral cirrhosis; but it is not yet known whether treatment of viral cirrhosis with α-interferon prevents this complication. Methods: The incidence and the risk (Cox regression analysis) of developing hepatocellular carcinoma were calculated in 347 patients with hepatic cirrhosis; 227 (34 hepatitis B virus and 193 hepatitis C virus related) were treated with α-interferon and 120 (28 hepatitis B virus and 92 hepatitis C virus) did not receive this treatment, in order to evaluate the efficacy of α-interferon in the prevention of hepatocellular carcinoma. In all patients, the cirrhosis was well compensated (Child A). Results: Over mean follow-up periods of 49 months for hepatitis B virus and 32 months for hepatitis C virus, 20 347 patients ( 6 62 hepatitis B virus and 14 285 hepatitis C virus) developed hepatocellular carcinoma. The risk of developing this tumor was significantly greater in males ( p<0.007) and in patients not treated with α-interferon ( p<0.01). The Relative Risk of developing hepatocellular carcinoma increased significantly ( p<0.0002) with each passing year. In patients with hepatic cirrhosis secondary to hepatitis B virus infections, the risk did not seem to be modified by α-interferon treatment, even though a greater, but not significant risk (Relative Risk=4.9; p=0.3) was calculated for untreated patients; in contrast, in hepatitis C virus-related cirrhosis, this risk was reduced by a factor of 4.0 ( p=0.04). The tumor developed only in non-responder patients regardless of virus type. After adjustment for confounding factors (sex, age, alcohol consumption, cigarette smoking), a statistically significant ( p<0.025) effect of interferon treatment in preventing hepatocellular carcinoma was still demonstrated when responders were matched with controls, but not when responders were compared with non-responders. Conclusions: These results show that, in addition to its ability to halt the progression of viral-induced liver disease, α-interferon is also of benefit in patients with hepatitis C virus cirrhosis who respond to this treatment by lowering their risk of developing hepatocellular carcinoma.
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