Hepatocellular carcinoma in southern Germany: epidemiological and clinicopathological characteristics and risk factors.
The aetiology of chronic liver disease leading to hepatocellular carcinoma (HCC) and the clinical characteristics of patients with HCC vary considerably internationally and intranationally. This study analyses the characteristics of HCC patients in southern Germany, a low endemic area of HCC.


METHODS
The files of 118 consecutive patients with HCC observed in a single tertiary care hospital between 1994 and 2000 have been reviewed. Epidemiological and clinicopathological characteristics such as age at presentation, ethanol consumption, serological hepatitis virus markers, and fibrosis were studied. Additionally, serum levels of alpha-fetoprotein (AFP) were analysed at the time of diagnosis in 77 patients.


RESULTS
The male:female ratio was 4:1 and the mean age at presentation was 61.8 years. Alcohol abuse (49.2%) and chronic hepatitis C infection (17.8%) were the most frequent risk factors. Histologically proven liver cirrhosis in the surrounding non-tumorous tissue was present in only 59.0% of cases. AFP levels were elevated in 78% of cases, but only 34% reached >500 ng/ml, a value considered to be significant for the diagnosis of HCC. AFP levels correlated with the stage of fibrosis.


CONCLUSIONS
The sensitivity of AFP serum levels as a tumour marker is poor but might help to detect at least a minority of cases. As in other populations within Europe, chronic alcohol abuse is frequently associated with HCC in southern Germany, confirming that alcohol is still the most important risk factor for hepatocarcinogenesis in areas with low hepatitis virus prevalence. Considering the poor prognosis of HCC, prevention is of pivotal importance, particularly for patients with chronic liver disease and other risk factors for the development of HCC.
Hellerbrand
C
C
Department of Internal Medicine I, University of Regensburg, Germany. claus.hellerbrand@klinik.uni-regensburg.de
Hartmann
A
A
Richter
G
G
Knöll
A
A
Wiest
R
R
Schölmerich
J
J
Lock
G
G
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D014408:Biomarkers, Tumor / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology; D016021:Epidemiologic Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D000509:alpha-Fetoproteins / Q000032:analysis*
D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins