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Abstract
The risk factors for the development of hepatocellular carcinoma (HCC) in patients who have achieved a long-term sustained viral response (SVR) to interferon (IFN) are not fully understood. This study aimed to investigate the characteristics of patients who developed HCC after 10 years of achieving SVR. We retrospectively studied 5 patients with HCC which developed more than 10 years after the termination of IFN therapy. The clinical characteristics at the induction of IFN therapy were male gender, a mean age of 51.6±9.1 years, while 2 patients were moderate alcohol consumers. None of the 5 patients were positive for either HBs Ag or anti-HBc Ab. A histological examination at the initial IFN therapy showed the activity scores to be A2 in all cases, and the fibrosis scores at least F2. The clinical parameters at the diagnosis of HCC included fluctuating transaminase levels in all cases. These levels scarcely fell below the upper limits even after SVR was achieved. In 3 patients, liver tissues were obtained at the treatment of HCC. These tissues showed marked improvement in both activities and fibroses, but severe steatosis in 1 patient. To conclude, chronic hepatitis C patients who respond to IFN therapy should undergo long-term follow-up, even after the eradication of HCV, with special attention particularly to patients who had elevated transaminase levels and steatosis.
Highlights
Hepatocellular carcinoma (HCC) is the major cause of cancerrelated death in Japan
In 5 patients, HCC was detected more than 10 years after the end of the IFN therapy
This suggests that IFN reduces the risk of HCC even in the non-sustained viral response (SVR) patient group
Summary
Hepatocellular carcinoma (HCC) is the major cause of cancerrelated death in Japan. Approximately 70-80% of HCCs in Japanese patients are associated with hepatitis C virus (HCV) infection [1]. Interferon (IFN) has been used for the treatment of chronic hepatitis C (CHC) patients. IFN therapy normalizes the serum ALT levels and leads to sustained eradication of HCV. These patients are commonly referred to as having achieved a sustained viral response (SVR) [7], and it has been noted that the cumulative incidence of HCC is significantly lower in SVR patients than in those with a non-response (NR) to IFN therapy [8,9], suggesting that the success of treatment for HCV infection is expected to significantly reduce the risk of developing HCC
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