title: Nonhepatic cancer in liver cirrhosis: a retrospective study of prevalence, complication rate after specific oncological treatment, follow-up and prognostic predictors of outcome in 354 patients with cirrhosis.
abstract: BACKGROUND
  Nonhepatic cancer risk of cirrhotic patients seems to be increased. Major surgery and chemotherapy in cirrhosis are associated with increased mortality and morbidity, which limits treatment.
  
  
  OBJECTIVE
  The aims of this study were analysis of (a) prevalence, (b) outcome after treatment, (c) of survival rate and (d) predictors of survival in a cirrhotic population.
  
  
  METHODS
  The study population was assembled retrospectively from a database of hospitalized patients (n=354). The Kaplan-Meier method was used to calculate the survival rate, and Cox regression analysis was performed to identify prognostic parameters.
  
  
  RESULTS
  Altogether, 84 neoplasms in 70 patients were observed. A total of 54 were nonhepatic (15.3%) mainly colorectal carcinoma, prostate cancer and tobacco-related neoplasms. TNM stage was the best prognostic parameter (p<0.0001). Low bilirubin (p=0.01), normal albumin (p=0.005) and absence of ascites (p<0.0001) were also related significantly to longer survival. The rate of postinterventional death after specific treatment was high. A proportion of patients received no specific therapy due to reduced physical performance, even in cases of limited disease.
  
  
  CONCLUSIONS
  Our data confirm the increased risk of cirrhotic patients for developing nonhepatic cancer. Advanced TNM stage was associated with reduced long-term survival. Scoring systems, such as Child's classification and Model of Elevated Liver Disease (MELD) score, were suitable parameters to predict mortality. Oncological management in patients with cirrhosis must be on an individual basis, independent from TNM classification.
authors.affiliation: Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Englschalkinger Straße 77, 81925 Munich, Germany. Felix.Gundling@gmx.de
authors.forename: Felix
authors.initials: F
authors.lastname: Gundling
authors.forename: Holger
authors.initials: H
authors.lastname: Seidl
authors.forename: Fabian
authors.initials: F
authors.lastname: Schmidtler
authors.forename: Nicola
authors.initials: N
authors.lastname: Löffler
authors.forename: Ingrid
authors.initials: I
authors.lastname: Strassen
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.forename: Christian
authors.initials: C
authors.lastname: Pehl
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schepp
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D009369:Neoplasms / Q000150:complications*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies