Hepatocellular carcinoma in Central Europe: prognostic features and survival

Background and aims-We investigated the influence of baseline characteristi cs of patients with hepatocellular carcinoma (HCC) on prognosis and develop ed a multivariate Cox model predicting survival. All patients were from Cen tral Europe. 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. Nineteen different clinical char acteristics and survival time from date of diagnosis were noted. Factors de termining survival time were analysed by univariate and multivariate analys is using Cox proportional hazard regression models and a new classification model was constructed. The validity of this model was tested on an indepen dent group of 89 patients, seen from April 1998 to September 1999. Results-Median survival in patients with HCC was 8.0 months. In a multivari ate analysis bilirubin (>2 mg/dl), portal vein thrombosis, prothrombin time (<70%), alpha fetoprotein (>180 mug/l), tumour mass >50%, and enlarged lym ph nodes were independent predictors of survival. A newly constructed Cox p roportional hazard model (Vienna survival model for HCC=VISUM-HCC) identifi ed three disease stages with different durations of survival (median surviv al stage 1, 15.2 months; stage 2, 7.2 months; and stage 3, 2.6 months; p=0. 00001). Applying the VISUM-HCC survival model to patients in Okuda stage 2 identified subgroups with an excellent and very poor prognosis for which di fferent treatment modalities should be offered. Conclusions-Our patients with HCC had a poor median survival of eight month s. Six easily measurable clinical variables were significant predictors of survival in patients with HCC. The new VISUM-HCC survival model may be usef ul for stratifying patients with HCC for various clinical treatment modalit ies.