Management of Hepatitis C Patients and Prevention of HCC

Masao Omata*. Department of Gastroenterology, University of Tokyo, Tokyo, Japan

Natural course of HCV infection: Previous studies including ours indicate the progression of fibrosis is steady but slow, and was estimated from 0.5 stages per year (normal-ALT) to 1.3. The efforts to establish non-invasive measures including Fibroscan helped us to relate the importance of liver fibrosis or rather “stiffness” of the liver to the development of HCC in a prospective fashion. To the end, the slow down of fibrosis progression or even reversal could obviously anticipated to reduce the incidence of HCC.

Chronic hepatitis: In 1994, we set up a national surveillance program for HCC development among chronic hepatitis C patients and enrolled about 2,900 biopsy-proven cases. 2,400 of them received interferon treatment, showing a sustained virologic response rate of 33% on average. The risk of HCC was reduced by half among the interferon-treated patients as a whole, and down to one-fifth among sustained virologic responders. Even among the cirrhotic, the incidence of HCC was decreased by long term follow-up. We also confirmed histologically the resolution of cirrhosis following sustained virologic response and the calculated rate of fibrosis regression rate was 0.28 fibrosis stage per year. It was also shown that, not only the reduction of HCC incidence, but also overall mortality including non-liver related death, was decreased.

Anti-viral for HCC: It could be assumed that the anti-viral could be only for prevention. However, our data clearly indicated that the eradication of HCV in patients who already developed HCC were also beneficial to prolong the patients’ life. Now, we are able to expect 80% 5-year survival rate in the combination of RFA and the eradication of HCV.