HBV相关的HCC的预防

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Editorial Prevention of HBV-related hepatocellular carcinoma (HCC). Therapy of chronic HBV infection that reduces associated hepatic necroinflammation is hypothesized to decrease the incidence of HCC. Reports of long-term follow-up data in support of this hypothesis have focused on studies of interferon therapy because lamivudine and adefovir dipivoxil have been available only in recent years. Only one randomized controlled trial investigating the incidence of HCC among interferon-treated patients has been conducted (Lin S-M, et al. Hepatology 1999; 29:971-975). In this study 101 HBeAg-positive Taiwanese men were randomized (2:1 ratio) to receive either interferon or no therapy. After a follow-up that ranged from 1 to 12 years, HCC was detected in 1.5% of interferon-treated patients compared to 12% of untreated patients (p = 0.04). The results of other non-randomized studies and case series of interferon therapy on the incidence of HCC have been mixed. A meta-analysis (Camma CM, et al. J Hepatol 2001; 34:593-602) including 7 studies with 853 interferon-treated patients and 652 untreated controls found interferon to have a significant protective effect. However, there was marked heterogeneity among the studies. In the August 2004 issue of the Journal of Viral Hepatitis, S-M Lin and others pooled data from 2 randomized controlled studies of HBeAg-positive patients conducted at the Chang Gung University and Memorial Hospital (Taipei, Taiwan). These studies included 34 patients who received placebo, 67 patients treated with natural lymphoblastoid interferon-alpha (IFN-αnl) (86 after prednisolone priming), and 109 patients treated with recombinant IFN α-2a (56 after prednisolone priming). Patients treated with IFN-αnl after prednisolone priming had the highest sustained response rate. After 11 years of follow-up, a greater percentage of placebo-treated patients (14.7%) than IFN-αnl-treated patients (1.5%, p <0.05) or IFN α-2a-treated patients (3.7%, p <0.05) developed HCC. In addition, the cumulative survival rate was lowest in the placebo group. Multivariate analysis identified IFN therapy as a significant predictor of decreased risk of HCC development and mortality. These data suggest that IFN therapy may reduce the incidence of HCC and prolong survival in patients with chronic HBV infection. A beneficial effect of IFN therapy on HCC development has not yet been observed in studies outside Asia possibly related to the short duration of follow-up and a lower incidence of HCC among Caucasians. (Lin S-M, et al. J Viral Hepat 2004; 11:349-357)