title: Clinical characteristics and time trends in etiology of hepatocellular cancer in Germany.
abstract: BACKGROUND
  The incidence of hepatocellular cancer (HCC) continues to rise in Europe with a shift of the primary cause towards alcoholic and non-alcoholic fatty liver disease. Metabolic factors like diabetes mellitus and overweight have been identified as significant risk factors for HCC development.
  
  
  METHODS
  A retrospective analysis in a large single-center cohort of 650 patients diagnosed with HCC was performed. Demographic characteristics, risk factors, tumor stage at diagnosis and survival were evaluated.
  
  
  RESULTS
  Among 650 patients (aged 17-87 years, with a male: female ratio of 4:1), 80.8% had underlying liver cirrhosis. Alcohol abuse was identified as the only risk factor for liver cirrhosis in 52.2% of patients. Viral infection with hepatitis C and hepatitis B was present in 13.7 and 3.6% of patients, respectively. 66.1% of patients with HCC were overweight with a body mass index exceeding 25, 25.5% even exceeding 30; 52% of patients had diabetes mellitus.
  
  
  CONCLUSIONS
  Strategies aiming at prevention and surveillance of patients at risk to develop HCC in the future need to widen the focus from patients with chronic viral hepatitis and a history of alcohol abuse to patients with metabolic risk factors.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schütte
authors.forename: Matthias
authors.initials: M
authors.lastname: Kipper
authors.forename: Stefan
authors.initials: S
authors.lastname: Kahl
authors.forename: Jan
authors.initials: J
authors.lastname: Bornschein
authors.forename: Tobias
authors.initials: T
authors.lastname: Götze
authors.forename: Daniela
authors.initials: D
authors.lastname: Adolf
authors.forename: Jörg
authors.initials: J
authors.lastname: Arend
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.forename: Hans
authors.initials: H
authors.lastname: Lippert
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006521:Hepatitis, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult