Epidemiology and survival of patients with hepatocellular carcinoma in Southern Germany

Abstract

Hepatocellular carcinoma (HCC) belongs to the most frequent tumors worldwide with an incidence still rising. Patients with cirrhosis are at the highest risk for cancerogenesis and are candidates for surveillance, and here, as well as for the choice of potential forms of treatment, identification of suitable parameters for estimating the prognosis is of high clinical importance. The aim of this study was to describe the etiology of underlying liver disease and to identify predictors of survival in a large single center cohort of HCC patients in Southern Germany. Clinicopathologi-cal characteristics and survival rates of 458 patients (83.6% male; mean age: 62.5+/-11.2 years) consecutively admitted to a University Hospital between 1994 and 2008 were retrospectively analyzed. The results indicate that chronic alcohol abuse was the most common risk factor (57.2%), followed by infection with hepatitis B and C viruses (HBV: 10.9% and HCV: 20.5%). Overall median survival was 19.0 months, and higher OKUDA, CHILD and CLIP scores correlated negatively with prognosis. Of these, only the CLIP Score was an independent predictor in multivariate analysis. We conclude that chronic alcohol abuse is frequently associated with HCC in low hepatitis virus endemic areas, such as Germany. Our study suggests the CLIP score as a valuable prognostic marker for patients' survival, particularly of patients with alcohol related HCC.

Keywords: CLIP score; HCC; epidemiology; hepatocellular carcinoma; survival.

Figure 1

Etiology of underlying liver disease of HCC patients. Data of 374 patients are depicted. Patients with incomplete information on risk factors (n=84) were excluded from analysis.

Figure 2

AFP serum levels at the time of diagnosis according to major etiologies. Data reflect a total of 241 patients who had (1) documented AFP levels at the time of diagnosis and (2) only one of the three major etiological factors: alcohol abuse or chronic hepatitis B (HBV) or hepatitis C (HCV) as a solitary risk factor. AFP levels are classified as normal (<10 ng/ml), moderately elevated (10-500 ng/ml) or considerably elevated (>500 ng/ml).

Figure 3

Kaplan-Meier survival curve of HCC patients. Data reflect 458 consecutive patients with HCC, both treated and untreated. Median survival was 19 months (95% Cl: 15.3-22.7).

Figure 4

Kaplan-Meier survival curve of patients stratified according to CLIP score. Comparison of patients with CLIP scores 0-3 provided validation of the excellent prognostic power of the CLIP score (as best predictor) in our study population. This analysis was based on total of 242 patients where complete data was available to calculate the CLIP scores 0-3.