特集名 | 肝炎のインターフェロン治療 -- 総まとめ | |
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題名 | C型肝炎のインターフェロン治療 (9) インターフェロン治療は肝細胞癌発生をどの程度抑制するか | |
発刊年月 | 2000年 10月 | |
著者 | 笠原 彰紀 | 大阪大学医学部附属病院総合診療部 |
著者 | 林 紀夫 | 大阪大学大学院医学系研究科分子制御治療学 |
【 要旨 】 | C型慢性肝炎に対するインターフェロン(IFN)治療施行例では未治療例に比し肝細胞癌発生の危険率は約1/2に低下していた.累積肝細胞癌併発率はIFN治療無効群,未治療群では経年的に漸増したが,著効,再燃群においては同等で,未治療群,無効群に比し有意に低率であった.IFN後7年では著効,再燃,無効群の累積肝細胞癌併発率はそれぞれ4.3,4.7,26.1%と予測された.IFN治療効果,年齢,性別が肝細胞癌発生に関与する有意な危険因子であり,著効群と再燃群,無効群と未治療群の危険率は同等で,著効群,再撚群の危険率は無効群,未治療群に比し約1/5に低下していた. C型慢性肝炎と診断された後5年間は,IFN治療群と未治療群の累積生存率は同等であったが,5年以降の累積生存率はIFN治療群に比し未治療群で低下し,8年目のIFN治療群における死亡の危険率は未治療群の約60%にまで低下していた.IFN治療効果別に検討すると,著効群,再燃群の累積生存率はほぼ同等で,無効群,未治療群に比し高率であった.また,IFN治療後に死亡する危険率は,無効群と未治療群は同等であったが,著効群,再燃群では未治療群の1/5以下にまで低下しており,肝癌死,肝不全死は認められなかった. 以上,C型慢性肝炎に対するIFN治療によりHCVの排除が認められなくてもトランスアミナーゼの正常化が認められれば,肝細胞癌の併発は有意に抑制され,生存率も改善することが明らかとなった. |
Theme | Interferon Therapy for Viral Hepatitis : an Update Handbook | |
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Title | Interferon Treatment for Chronic Hepatitis C can Reduce the Development of Hepatocellular Carcinoma and Decrease Mortality in Patients with Hepatitis C Virus Eradication and/or ALT Normalization | |
Author | Akinori Kasahara | Department of General Medicine, Osaka University Hospital |
Author | Norio Hayashi | Department of Molecular Therapuetics, Osaks University Graduate School of Medicine |
[ Summary ] | The cumulative incidence of hepatocellular carcinoma (HCC) was higher in chronic hepatitis C patients not receiving interferon treatment than in those receiving this treatment. Multivariate analysis showed that interferon treatment decreased the risk of developing HCC by 48% compared to chronic hepatitis C patients without interferon treatment. The cumulative incidence of HCC in transient responders was almost equal to that in sustained responders. It was significantly higher in non-responders than in sustained or transient responders. The seven-year cumulative incidence rates for HCC in sustained responders, transient responders, and non-responders were estimated to be 4.3%, 4.7% and 26.1%, respectively. The risk of HCC development was not elevated in transient responders, compared to sustained responders, but the risk was five times higher in non-responders compared to sustained responders. The cumulative survival rates for chronic hepatitis C patients treated with interferon and those without interferon treatment were nearly identical during the first five years following diagnosis. Thereafter, the cumulative survival rate for patients without interferon treatment declined, resulting in the eight-year survival rate being higher for interferon-treated patients than for those without interferon treatment. The cumulative survival rate in transient responders was almost equal to that in sustained responders. It was significantly lower in non-responders and those not receiving interferon treatment than in sustained or transient responders. No sustained responder or transient responder in the group of interferon treated chronic hepatitis C patients died of liver-related disease. Interferon treatment was demonstrated to lower the incidence of HCC and improve long-term survival rates among patients with chronic hepatitis C, for whom interferon was effective in normalizing ALT, even when HCV was not eradicated. |