Petry W, Heintges T, Hensel F, Erhardt A, Wenning M, Niederau C, Häussinger D
Medizinische Klinik und Poliklinik, Heinrich-Heine-Universität, Düsseldorf.
Z Gastroenterol. 1997 Dec;35(12):1059-67.
Chronic hepatitis C and B are the main causes of hepatocellular carcinoma (HCC) worldwide. Little is known about the etiology of HCC in Germany which is regarded as a low-prevalence area for viral hepatitis C (HCV) and B (HBV). To assess the etiologic factors of HCC in Germany we have retrospectively analyzed the records of 100 consecutive patients with hepatocellular carcinoma in our clinic. HCC-patients with documented status on HCV/HBV-infection and daily alcohol intake (n = 55) had HCV antibodies in 53%, HBs-Ag in 20%, isolated chronic alcohol abuse in 11% and genetic hemochromatosis in 2%. In 13% of the HCC-patients no risk factor could be identified. Coinfections with HCV and HBV were not observed. Liver cirrhosis was present in 90% of the HCC-patients. In histologically confirmed HCC (n = 71) serum alpha-fetoprotein level was normal (< 8.5 ng/ml) in 20%, moderately elevated (8.5-300 ng/ml) in 48% and considerably elevated (> 300 ng/ml) in 32% of the patients. Only 31% of all patients presented with small single lesions (< or = 5 cm) without evidence for extrahepatic metastases or portal vein thrombosis. Only 30% of the HCC-patients could be treated with a curative intention (28 hepatic resections, one orthotopic liver transplantation). Patients who underwent resection had cumulative 6-month, 1-year, 2-year and 3-year survival rates of 83.8%, 65.9%, 54.3% and 24.8% respectively. Median survival time after resection was 24.8 months compared with 5.8 months in symptomatically treated patients with unresectable HCC (n = 39). Patients with hepatitis C-associated HCC were significantly older than patients with hepatitis B-associated HCC (mean values: 63.2 vs. 54.2 years). Frequency of cirrhosis, tumor stage, alpha-fetoprotein level and prognosis did not differ between groups. In conclusion hepatocellular carcinoma was predominantly associated with chronic HCV-infection. Most patients presented with normal or moderately elevated serum AFP-levels. Prognosis was poor even after hepatic resection.
慢性丙型肝炎和乙型肝炎是全球肝细胞癌（HCC）的主要病因。在德国，肝细胞癌的病因鲜为人知，该国被视为丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）低流行地区。为评估德国肝细胞癌的病因，我们回顾性分析了我院100例连续肝细胞癌患者的病历。记录了HCV/HBV感染状态和每日酒精摄入量的HCC患者（n = 55）中，53%有HCV抗体，20%有乙肝表面抗原（HBs-Ag），11%为单纯慢性酒精滥用，2%为遗传性血色素沉着症。13%的HCC患者未发现危险因素。未观察到HCV和HBV合并感染。90%的HCC患者存在肝硬化。在组织学确诊的HCC患者（n = 71）中，20%的患者血清甲胎蛋白水平正常（< 8.5 ng/ml），48%中度升高（8.5 - 300 ng/ml），32%显著升高（> 300 ng/ml）。所有患者中仅31%表现为单个小病灶（≤ 5 cm），无肝外转移或门静脉血栓形成证据。仅30%的HCC患者可接受根治性治疗（28例肝切除术，1例原位肝移植）。接受肝切除术的患者6个月、1年、2年和3年的累积生存率分别为83.8%、65.9%、54.3%和24.8%。肝切除术后的中位生存时间为24.8个月，而不可切除HCC的对症治疗患者（n = 39）的中位生存时间为5.8个月。丙型肝炎相关HCC患者显著比乙型肝炎相关HCC患者年龄大（平均值：63.2岁对54.2岁）。两组之间的肝硬化发生率、肿瘤分期、甲胎蛋白水平和预后无差异。总之，肝细胞癌主要与慢性HCV感染相关。大多数患者血清甲胎蛋白水平正常或中度升高。即使肝切除后预后也较差。
