Effect of peginterferon alfa-2b and ribavirin on hepatocellular carcinoma prevention in older patients with chronic hepatitis C.

Background and Aims The population of patients chronically infected with hepatitis C virus ( HCV) is aging, and the number of older patients with HCV-related hepatocellular carcinoma ( HCC) is increasing. The purpose of this study was to elucidate the effects of peginterferon and ribavirin combination therapy on prevention of HCC in older patients with chronic hepatitis C ( CH- C). Methods We compared the sustained virological response ( SVR) and treatment discontinuation rates between older (≥ 65 years) and younger patients (< 65 years) among 1280 CH- C patients treated with peginterferon alfa-2b and ribavirin. Cumulative incidence of HCC was determined by Kaplan- Meier analysis, and factors associated with liver carcinogenesis were analyzed by Cox proportional hazards regression. Results Older patients had a significantly lower SVR rate and a significantly higher discontinuation rate of treatment than younger patients. Fifty patients developed HCC during median follow-up period of 47 months. Cox proportional hazards regression analysis indicated that the following were independent risk factors associated with the development of HCC: older age, male, advanced fibrosis, non- SVR in all patients: higher gamma-glutamyltranspeptidase, and non- SVR in older patients. Older patients who achieved SVR had a significantly reduced rate of HCC compared with those who did not achieve SVR, especially those who had gamma-glutamyltranspeptidase over 44 IU/ L. Conclusions The SVR rate was lower and the combination therapy discontinuation rate was higher in older CH- C patients than in younger patients. However, older patients who achieved SVR had a markedly lower rate of HCC development compared with older patients who did not achieve SVR. [ABSTRACT FROM AUTHOR]