Postoperative peg-interferon plus ribavirin is associated with reduced recurrence of hepatitis C virus-related hepatocellular carcinoma§

Authors

  • Yao-Chun Hsu,

    1. Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
    2. Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
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  • Hsiu J. Ho,

    1. School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
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  • Ming-Shiang Wu,

    1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Jaw-Town Lin,

    Corresponding author
    1. Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
    2. School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
    3. Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan
    • Jaw-Town Lin, Chair Professor, School of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205, Taiwan===

      Chun-Ying Wu, Faculty of Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan===

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    • fax: +886-2-23947899

  • Chun-Ying Wu

    Corresponding author
    1. Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
    2. Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
    3. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    4. College of Public Health, China Medical University, Taichung, Taiwan
    5. Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan
    • Jaw-Town Lin, Chair Professor, School of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205, Taiwan===

      Chun-Ying Wu, Faculty of Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan===

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    • fax: +886-4-23741331


  • Potential conflict of interest: Yao-Chun Hsu reports having received lecture fees from Merck Sharp & Dohme (Taiwan), Roche (Taiwan), and Bristol-Myers Squibb (Taiwan). There is no other conflict of interest to declare.

  • This work is supported by Taiwan's National Health Research Institutes (PH-100-PP-54, PH-101-PP-23) and based on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by the National Health Research Institutes. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health or the National Health Research Institutes. URL: http://www.nhri.org.tw/nhird/en/index.htm.

  • §

    Preliminary results of this study were presented at the 63rd annual meeting of the American Association for the Study of Liver Diseases (the Liver Meeting ® 2012) on November 12, 2012; Boston, MA.

Abstract

Hepatocellular carcinoma (HCC) frequently recurs after surgical resection. This population-based research aimed to investigate the association between postoperative antiviral treatment and risk of recurrent HCC in patients with hepatitis C virus (HCV) infection. By analyzing the Taiwan National Health Insurance Research Database, we initially screened a total of 100,938 patients diagnosed with HCC for the first time between October 2003 and December 2010. Among 2,237 antiviral-naïve HCV-infected patients with curatively resected HCC, there were 213 patients receiving antiviral treatment with pegylated interferon plus ribavirin for 16 weeks or more after surgery (treated cohort). These treated patients were matched 1:4 with 852 controls who were never treated for HCV infection (untreated cohort) by age, gender, cirrhosis, and the elapsed time between surgery and antiviral therapy. Cumulative incidences of and hazard ratios for recurrent HCC were calculated after adjusting for competing mortality. The recurrence rate of HCC was significantly lower in the treated than untreated cohort, with 52.1% (95% confidence interval [CI], 42.0-62.2%) and 63.9% (95% CI, 58.9-68.8%) after 5 years of follow-up, respectively (P = 0.001). The number needed to treat for one fewer recurrent HCC at 5 years was 8. The association between postoperative antiviral treatment and risk of recurrent HCC was independent of adjustment for multiple covariates, with an adjusted hazard ratio of 0.64 (95% CI, 0.50-0.83). Stratified analyses revealed that the attenuation in recurrence risk was greater in patients younger than 60 years and those without cirrhosis or diabetes. Conclusion: Postoperative pegylated interferon plus ribavirin is associated with reduced recurrence of HCC in patients with HCV infection. Age, liver cirrhosis, and diabetes mellitus appear to modify this association. (HEPATOLOGY 2013)

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