Interferon Therapy after Tumor Ablation Improves Prognosis in Patients with Hepatocellular Carcinoma Associated with Hepatitis C Virus

18 February 2003 | Volume 138 Issue 4 | Pages 299-306

Background: Even after the surgical or medical treatment of hepatocellular carcinoma, tumors frequently develop at new foci, leading to a poor prognosis.

Objective: To assess whether combined tumor ablation and interferon therapy can reduce the occurrence of new foci of hepatocellular carcinoma, thereby improving survival rate.

Design: Randomized, controlled study.

Setting: University hospital.

Patients: 74 patients with compensated cirrhosis, three or fewer nodules of hepatocellular carcinoma, and low hepatitis C virus RNA loads ( 2 x 10⁶ copies/mL).

Intervention: After all patients had complete ablation of lesions by percutaneous ethanol injection therapy, 49 patients were assigned to receive 6 million U of interferon three times weekly for 48 weeks and 25 did not receive treatment.

Measurements: Abdominal ultrasonography, computed tomography, and determination of blood biochemical measures.

Results: Of the 49 patients treated with interferon, 21 showed a sustained biochemical response and 14 showed a sustained virologic response. The rate of first recurrence of new foci of hepatocellular carcinoma was similar in patients treated with interferon and untreated patients; however, the rates of second or third recurrence seemed to be lower in the interferon group than in the untreated group. Patients treated with interferon had a survival rate of 68% at 5 years and 53% at 7 years; untreated patients had a survival rate of 48% at 5 years and 23% at 7 years.

Conclusion: After tumor ablation by ethanol injection, interferon therapy may enhance patient survival in selected patients with chronic hepatitis C.

Editors' Notes Context Hepatocellular carcinoma often follows hepatitis C virus infection. Currently available treatments for hepatocellular carcinoma are unsatisfactory. Percutaneous ethanol injection therapy into tumor nodules shows some promise, but recurrence rates are high. Contribution In a carefully selected group of 74 patients with multicentric hepatocellular carcinoma, mild hepatitis C, and mild cirrhosis, patients randomly assigned to receive interferon in addition to ethanol injections showed improved survival at 5 and 7 years, particularly among patients with a sustained virologic response. Cautions Combined treatment of multicentric hepatocellular carcinoma offers the possibility of enhanced survival for carefully selected patients; this study is small, however, and enrolled only patients with low virus levels and mild cirrhosis. –The Editors

 

Author and Article Information

From University of Tokyo, Tokyo, Japan.

Requests for Single Reprints: Yasushi Shiratori, MD, Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan; e-mail, shirato{at}cc.okayama-u.ac.jp.

Current Author Addresses: Dr. Shiratori, Department of Gastroenterology, Hepatology, and Infectious Diseases, Okayama University School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama-city, Okayama 700, Japan

Drs. Shiina, Teratani, Imamura, Obi, Sato, Koike, Yoshida, and Omata: Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.

Author Contributions: Conception and design: Y. Shiratori, S. Shiina, T. Teratani, M. Imamura, S. Obi, S. Sato, Y. Koike, H. Yoshida, M. Omata.

Analysis and interpretation of the data: Y. Shiratori, H. Yoshida.

Drafting of the article: Y. Shiratori.

Critical revision of the article for important intellectual content: Y. Shiratori, S. Shiina, T. Teratani, M. Imamura, S. Obi, S. Sato, Y. Koike, H. Yoshida, M. Omata.

Final approval of the article: Y. Shiratori, M. Omata.

Provision of study materials or patients: Y. Shiratori, S. Shiina, T. Teratani, M. Imamura, S. Obi, S. Sato, Y. Koike, M. Omata.

Statistical expertise: Y. Shiratori, H. Yoshida.

Obtaining of funding: Y. Shiratori, M. Omata.

Administrative, technical, or logistic support: Y. Shiratori, M. Omata.

Collection and assembly of data: Y. Shiratori, S. Shiina, T. Teratani, M. Imamura, S. Obi, S. Sato, Y. Koike.