The efficacy of interferon therapy against hepatitis C virus (HCV) has much improved, showing a sustained virologic response rate of 40–50% even in the genotype 1b with a high viral load. Several cohort studies conducted in Japan in the 1990s unanimously concluded that the risk of hepatocellular carcinoma (HCC) development was reduced in patients who achieved a sustained virologic response or persistent normalization of alanine aminotransferase as compared to untreated patients. Recently, a large-scale randomized controlled trial, called the HALT-C study, showed no significant difference in the incidence of HCC between patients on maintenance interferon therapy and those without. The reason for the discrepant results in Japanese and USA studies needs further clarification, together with analysis of the difference in incidence rates of HCC among cirrhotic patients. There has also been progress in the treatment of HCC, and together with advances in diagnostics facilitating HCC detection at an early stage, tumor nodules can often be completely removed either by medical ablation or surgical resection. Nevertheless, recurrence of HCC after apparently curative treatment is extraordinarily frequent, since the remaining liver is still at a high risk of HCC. The prevention of the recurrence of HCC, or tertiary prevention, is currently one of the most challenging tasks in hepatology.
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