Kubicka S, Rudolph K L, Hanke M, Tietze M K, Tillmann H L, Trautwein C, Manns M
Department of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Germany.
Liver. 2000 Jul;20(4):312-8. doi: 10.1034/j.1600-0676.2000.020004312.x.
AIMS/BACKGROUND: This study was undertaken in order to assess the main features of hepatocellular carcinoma in Germany, a country with low incidences of this tumor.
Two hundred and eighty consecutive patients with hepatocellular carcinomas admitted to the Medical School Hannover between 1993-1997 were retrospectively studied.
Reliable data for the assessment of the etiology and the tumor stage of HCC were available for 268 patients. The female/male ratio was 1/4. In 51.9% of the patients, HCC was associated with hepatitis virus B or C (HBV, HCV) infection: 35.1% with HBV, 26.9%) with HCV and 10% coinfection with HBV/HCV This result emphasizes the major impact of HBV and HCV infection in liver cancer in Germany. Of all patients with HCC 74.6%) had liver cirrhosis. The predominant majority of the HCC (87%) were restricted to the liver: in only 5.9% could regional lymph node metastases as well as 8.5%) metastases in other organs be clinically diagnosed by chest X-ray, computed tomography scan or sonography. Data to asses the Okuda tumor stage were available for 166 patients: 47% were classified as stage I, 47% as stage II and only 6% as stage III. Serum AFP were determined in 195 patients. In 66% of the patients, the AFP value was elevated, but only in 30% did the AFP level reach the value of 500 microg/l, which is considered to be significant for HCC diagnosis in patients with liver cirrhosis. The proportion of liver cirrhosis was higher in HCV (97.8%) versus HBV (80.6%) associated HCC, which was the only significant (p<0.05) difference in the characteristics of HCC according to the etiology.
Our study shows that liver cirrhosis is the prime risk factor for hepatocarcinogenesis in Germany. However, the very high proportion of hepatitis virus related HCC, in particular the high proportion of HBV infections, contradicts the common view that alcohol is by far the most important etiological factor for hepatocarcinogenesis in low hepatitis virus endemic areas such as Germany.
目的/背景：本研究旨在评估德国肝细胞癌的主要特征，该国该肿瘤发病率较低。
对1993年至1997年间汉诺威医学院收治的280例连续性肝细胞癌患者进行回顾性研究。
268例患者有用于评估肝癌病因和肿瘤分期的可靠数据。男女比例为1/4。51.9%的患者肝癌与乙型或丙型肝炎病毒（HBV、HCV）感染有关：35.1%与HBV有关，26.9%与HCV有关，10%为HBV/HCV合并感染。这一结果强调了HBV和HCV感染在德国肝癌中的主要影响。所有肝癌患者中74.6%有肝硬化。绝大多数肝癌（87%）局限于肝脏：仅5.9%可通过胸部X线、计算机断层扫描或超声在临床上诊断出区域淋巴结转移以及8.5%的其他器官转移。166例患者有评估奥田肿瘤分期的数据：47%被分类为I期，47%为II期，仅6%为III期。195例患者检测了血清甲胎蛋白（AFP）。66%的患者AFP值升高，但仅30%的患者AFP水平达到500μg/l，这一数值被认为对肝硬化患者的肝癌诊断有意义。与HBV（80.6%）相关的肝癌相比，HCV相关肝癌的肝硬化比例更高（97.8%），这是根据病因在肝癌特征方面唯一显著（p<0.05）的差异。
我们的研究表明，肝硬化是德国肝癌发生的主要危险因素。然而，与肝炎病毒相关的肝癌比例非常高，尤其是HBV感染比例很高，这与通常认为在德国等低肝炎病毒流行地区酒精是肝癌发生最重要病因的观点相矛盾。
