[Hepatocellular carcinoma: the significance of cirrhosis for treatment and prognosis--retrospective study].
OBJECTIVE
To determine whether the presence of liver cirrhosis was related to the treatment options and survival of patients with hepatocellular carcinoma (HCC).


METHODS
Retrospective.


METHODS
A status investigation of all HCC patients who were treated in the period 2000-2007 at the Erasmus MC Hospital, Rotterdam, was performed. The treatments were analysed and the disease-free and total survival rate were calculated.


RESULTS
HCC was diagnosed in 461 patients during the study period. Cirrhosis was present in 295 patients (64%). Treatment with curative intent was pursued in 184 patients through partial liver resection, orthotopic liver transplantation or radiofrequency ablation. The group of patients without cirrhosis contained significantly more women (38% versus 18%) (p < 0.001), showed less hepatitis B or C infection (34% versus 74%) (p < 0.001) and had a larger median tumour size (80 mm (range: 3-227) versus 35 mm (range: 8-200)) (p < 0.001). Patients without cirrhosis were mainly treated by partial liver resection (37% versus 10%) (p < 0.001) and less by liver transplantation (1% versus 13%) (p < 0.001) or radiofrequency ablation (5% versus 16%) (p = 0.001). Median follow-up was 31 months (range: 1-108). Without stratification according to treatment, the overall 3-year survival in patients with non-cirrhotic and cirrhotic HCC was 30% and 32%, respectively (difference not significant). Patients who had undergone potential curative treatment in cirrhotic or non-cirrhotic livers had a 3-year survival rate of 54% and 59%, respectively (difference not significant). The recurrence rate of HCC without cirrhosis was 39%, of which 31% in the first year. The recurrence rate with cirrhosis was 37%, of which 23% in the first year (difference not significant).


CONCLUSIONS
The presence of liver cirrhosis was strongly associated with treatment options for patients with HCC but not with the prognosis for a recurrence of HCC or the survival rate following potential curative treatment.
Witjes
Carlijn D M
CD
Erasmus MC, Rotterdam, Afd. Heelkunde, Hepatobiliaire en Transplantatie Chirurgie, the Netherlands.
de Man
Robert A
RA
Eskens
Ferry A L M
FA
Dwarkasing
Roy S
RS
Zondervan
Pieter E
PE
Verhoef
Cornelis
C
Ijzermans
Jan N M
JN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery / Q000628:therapy* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult