HEPATOCELLULAR-CARCINOMA IN GERMANY - EPI DEMIOLOGY, ETIOLOGY, CLINICAL-FEATURES AND PROGNOSIS IN 100 CONSECUTIVE PATIENTS OF A UNIVERSITY CLINIC

Chronic hepatitis C and B are the main causes of hepatocellular carcin oma (HCC) worldwide. Little is known about the etiology of HCC in Germ any which is regarded as a low-prevalence are for viral hepatitis (HCV ) and B (HBV). - To assess the etiologic factors of HCC in Germany we have retrospectively analyzed the records of 100 consecutive patients with hepatocellular carcinoma in our clinic. - HCC-patients with docum ented status on HCV-/HBV-infection and daily alcohol intake (n = 55) h ad HCV antibodies in 53%, HBs-Ag in 20%, isolated chronic alcohol abus e in 11% and genetic hemochromatosis in 2%. In 13% of the HCC-patients no risk factor could be identified. Coinfections with HCV and HBV wer e not observed. Liver cirrhosis was present in 90% of the HCC-patients . In histologically confirmed HCC (n = 71) serum alpha-fetoprotein lev el was normal (< 8.5 ng/ml) in 20%, moderately elevated (8.5-300 ng/ml ) in 48% and considerably elevated (> 300 mg/ml) in 32% of the patient s. Only 31% of all patients presented with small single lesions (less than or equal to 5 cm) without evidence for extrahepatic metastases or portal vein thrombosis. Only 30% of the HCC-patients could be treated with a curative intention (28 hepatic resections, one orthotopic live r transplantation). Patients who underwent resection had cumulative 6- month, 1-year, 2-year and 3-year survival rates of 83.8%, 65.9%, 54.3% and 24.8% respectively. Median survival time after resection was 24.8 months compared with 5.8 months in symptomatically treated patients w ith unresectable HCC (n = 39). Patients with hepatitis C-associated HC C were significantly older than patients with hepatis B-associated HCC (mean values: 63.2 vs. 54.2 years). Frequency of cirrhosis, tumor sta ge, alpha-fetoprotein level and prognosis did not differ between group s. In conclusion hepatocellular carcinoma was predominantly associated with chronic HCV-infection. Most patients presented with normal or mo derately elevated serum AFP-levels. Prognosis was poor even after hepa tic resection.