Prognostic effect of response to interferon therapy after laparoscopic splenectomy among patients with marked thrombocytopenia and hepatitis C virus-related cirrhosis.

Abstract

Laparoscopic splenectomy enables patients with marked thrombocytopenia and hepatitis C virus (HCV)-related cirrhosis to receive sufficient interferon-based therapy. The purpose of this study was to evaluate whether the response to interferon after laparoscopic splenectomy contributes to the survival of cirrhotic patients with marked thrombocytopenia. Eighty-seven patients with marked thrombocytopenia and HCV-related cirrhosis who met the inclusion criteria were enrolled. Of the 87 patients, 65 underwent laparoscopic splenectomy for IFN therapy, and 22 patients declined laparoscopic splenectomy and IFN therapy. Finally, 61 patients received IFN therapy after splenectomy, and 26 patients did not receive IFN therapy. The numbers of patients in the sustained virological response (SVR) group, the transient response (TR) group, the no response (NR) group, and the no interferon (IFN) group were 25, 12, 24, and 26, respectively. Seven-year survival in the SVR group, the TR group, NR group, and the no IFN group was 86, 76, 44, and 42%, respectively. When the response group was defined as the SVR or TR group, survival was significantly higher for the response group than for the other groups. However, there was no significant difference between survival in the NR and no IFN groups. On multivariate analysis, independent factors related to survival were the response to interferon, the presence of esophageal varices, and a history of treatment for hepatocellular carcinoma. A good response to interferon after splenectomy was associated with a favorable prognosis. Therefore, prediction of the efficacy of IFN therapy is crucial before splenectomy.