Long-Term Follow-Up of Chronic Hepatitis C Patients Treated with Interferon-Alpha: Risk of Cirrhosis and Hepatocellular Carcinoma in a Single Center over 10 Years

Abstract

Objectives: Interferon (IFN)-based therapy for chronic hepatitis C (CHC) is cost-effective and is associated with reduced risk of disease progression. We aimed to assess the incidence of cirrhosis and hepatocellular carcinoma (HCC) and to identify risk factors associated with disease progression. Methods: We retrospectively reviewed 280 CHC patients who were registered at our hospital between 2001 and 2010. Results: About 80% of patients received antiviral treatment. The 10-year cumulative incidence of cirrhosis was significantly lower among patients who received antiviral therapy than among those who did not (8.3 vs. 44.0%; p = 0.001). Among them, patients with sustained virological response (SVR) had a significantly lower incidence of cirrhosis than those without SVR (0.6 vs. 33.9%; p < 0.001). Cox proportional hazards regression showed that SVR was the significant independent factor for reducing the risk of cirrhosis (hazard ratio, HR = 0.03; p = 0.034). The 10-year cumulative incidence of HCC was higher among patients who did not receive antiviral therapy than among those who did (43.9 vs. 6.1%; p < 0.001). Multivariate analysis showed that underlying cirrhosis was the only independent risk factor associated with HCC development (HR = 7.70; p = 0.010). Conclusions: SVR secondary to IFN-based therapy could reduce cirrhosis development in CHC patients. Underlying cirrhosis was the strongest predictor of HCC development.

Long Term Follow Up of Chronic Hepatitis C Patients: Will Sustained Virological Response be Enough to Prevent Cirrhosis in The Long Term?

“…The increase in the incidence of cirrhosis may be explained by the fact that the vast majority of our patients (96%) were infected with the more aggressive genotype (genotype 1). Annual rate of cirrhosis was found to be 2.26-5% in previous studies for the untreated patients [8,9] , which was similar to our results (4.44%). The annual rate of cirrhosis (1.95%) was significantly declined in treated group.…”

“…C. Koh et al [14] and Morisco F et al [15] also showed that CHC patients with SVR has a markedly reduced risk for relapse and cirrhosis (0.97%, 0.77 respectively). Lee HJ et al [8] followed up 280 CHC patients for 10 years in Korea and the cumulative incidences of cirrhosis were found to be 0.6% in patients with SVR, 33.9% in patients without SVR and 44.4% in untreated group. In this study, similar results were observed as treated patients without SVR had lower cirrhosis incidence comparing to untreated patients, although it was not statistically significant.…”

Achieving sustained virologic response in hepatitis C: a systematic review of the clinical, economic and quality of life benefits

“…2008 [ 64 ] Japan 209 4.1 years a Retrospective cohort study in patients who underwent curative surgery for early stage HCC (n = 139 had no antiviral treatment, remainder treated with pegIFN plus ribavirin) Tumor-free survival and recurrence of HCC Tumor-free survival rate at 5 years was 54% for SVR group vs. 23% for non-SVR/untreated group (p < 0.001) Lee et al . 2013 [ 80 ] South Korea 315 45 months a Retrospective chart review, 86% patients treated, 15% with cirrhosis at baseline, SVR rate of 75% Cirrhosis Cumulative 5 year rate of cirrhosis was 27.6% for patients without SVR vs. 0% for patients with SVR (p < 0.01) Canete et al . 2013 [ 81 ] Spain 105 9.3 years Retrospective study of paired biopsy data in HCV patients with mild-moderate fibrosis treated with IFN plus ribavirin Progression of fibrosis Progression of fibrosis was reported in 5.3% patients with SVR and 50% patients with non-response (p < 0.0001).…”