Hepatocellular carcinoma in Austria: aetiological and clinical characteristics at presentation

Background and aims The aetiology of chronic liver disease leading to hepat ocellular carcinoma (HCC) and the clinical characteristics at the time of p resentation vary considerably among different parts of the world and over t ime. The number of patients seen at our institution has increased as compar ed to a period 20 years earlier. We investigated baseline characteristics o f patients with hepatocellular carcinoma such as cirrhosis, hepatitis virus markers, age at presentation and stage of the tumour in an area with low p revalence of viral hepatitis. Methods All 245 patients seen at the Department of Gastroenterology and Hep atology at the University of Vienna, Austria, from July 1991 to March 1998 were included in this retrospective study, and 19 different clinical charac teristics were studied. Results The median age at detection of HCC was 63.3 years, and alcoholic li ver disease (35.1%) and hepatitis C virus (HCV) infection (36.7%) were the most frequent underlying diseases. Both chronic alcoholism and HCV infectio n as risk factors were present in 6.9% of the patients. Liver cirrhosis was present in 86.5%. At the time of diagnosis, 43.5% had multi-nodular tumour s. Of the remaining patients with a single nodule, only 10% had HCC less th an or equal to 2 cm. Most of our patients presented at a late stage of the disease (TNM stage 3 29.4%, TNM stage 4 69.7%; Okuda stage 2 65.7%, Okuda s tage 3 18.0%). Due to the late stage of the disease at the time of presenta tion, 145 patients (59.2%) received palliative care only, 24 (9.8%) underwe nt liver resection, 38 (15.5%) liver transplantation and 38 (15.5%) chemoth erapy, Conclusions In this large single-centre series of HCC, the dominant contrib ution of HCV infection and chronic alcohol abuse as the underlying aetiolog y is documented. Diagnosis is usually made very late as reflected in the hi gh proportion of patients in TNM stages 3 and 4 or Okuda stages 2 and 3. Th is resulted in a high percentage of patients who received palliative care o nly and very few who were eligible for treatment modalities with curative p otential such as resection and liver transplantation. (C) 2000 Lippincott W illiams & Wilkins.