RETROSPECTIVE ANALYSIS OF THE EFFECT OF INTERFERON THERAPY ON THE CLINICAL OUTCOME OF PATIENTS WITH VIRAL CIRRHOSIS

BACKGROUND. Recent data suggest that interferon therapy (IFN) can redu ce the risk of progression to hepatocellular carcinoma (HCC) in patien ts with hepatitis C virus (HCV)-related cirrhosis. METHODS. A cohort o f 189 patients with Child's Stage A cirrhosis of viral etiology follow ed prospectively were analyzed retrospectively to assess the effects o f IFN on the clinical course and development of HCC. RESULTS. During a mean follow-up of 71.5 +/- 23.6 months, 7.9% of 88 treated and 21.8% of 101 untreated patients showed worsening of the Child's disease stag e (P < 0.01); 5.6% of treated and 26.7% of untreated patients develope d HCC (P < 0.001); and 3.4% of treated and 19.8% of untreated patients died of liver disease or underwent orthotopic liver transplantation ( OLT) (P < 0.005). Using Cox's regression analysis, no treatment with I FN, high bilirubin and alkaline phosphatase (ALP) levels, and low leuk ocyte counts and prothrombin activity (PT) were associated significant ly with worsening of Child's disease stage; no treatment with IFN, lon g term disease, low albumin and PT, and high gamma-glutamyl transpepti dase (GGT) were related significantly to HCC development; and no treat ment with IFN, low albumin and PT, and high GGT and ALP were associate d significantly with reduced survival. After adjustment for independen t risk factors identified by multivariate analysis, the estimated cumu lative probability of worsening of cirrhosis (P < 0.05), development o f HCC (P < 0.001), and death or OLT (P < 0.005) was significantly lowe r in IFN-treated patients compared with untreated patients. This benef icial effect of therapy was statistically evident only in HCV positive patients. CONCLUSIONS. These results support the hypothesis that IFN improves clinical outcomes and reduces progression to HCC in patients with HCV-related cirrhosis. These conclusions, based on retrospective data, should be confirmed prospective. (C) 1998 American Cancer Societ y.