The tertiary prevention of hepatocellular carcinoma in chronic hepatitis C patients

Background and Aim: Pegylated interferon‐alpha plus ribavirin combination (PegIFN/RBV) therapy possesses positive effect in the secondary prevention of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. The current study aimed to assess its efficacy in the tertiary prevention and to validate the performance of the MHC class I polypeptide‐related chain A (MICA) level in the prediction of hepatocellular carcinoma (HCC) recurrence. Methods: A multi‐center study enrolling 105 consecutive HCC patients post curative therapies were prospectively recruited. The primary outcome measurement was recurrence of HCC. Results: The mean observational period was 52.7 months (range = 3.9–121.5 months). Fifty‐six (53.3%) patients achieved sustained virological response (SVR). After completion of treatment, 43 (41.0%) patients developed HCC recurrence, and 24 (55.8%) of them had their recurrence within 6 months after completion of therapy. Thirty‐three (76.7%) of the patients with HCC recurrence were of de novo pattern. Those responders tended to have a lower cumulative incidence of recurrence than those non‐responders (43.2 vs 84.8/100 person‐month, log‐rank P  = 0.13). Those non‐responders with a high MICA level (>100 pg/mL) carried the lowest cancer‐free survival than those non‐responders with a low MICA level and those responders ( P  = 0.002). Cox regression hazard analysis showed high baseline MICA level (Odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.1–20.8, P  = 0.04) and a low platelet count (<100 000/mm 3 ) (OR = 5.4, 95% CI = 1.1–27.0, P  = 0.04) predicted HCC recurrence. Conclusions: PegIFN/RBV therapy carried a limited effect in the tertiary prevention of HCC. A high MICA level predicted HCC recurrence, particularly among those non‐responders.