Das hepatozelluläre Karzinom ist das häufigste primäre Lebermalignom. In den meisten Fällen entwickelt sich der Tumor auf dem Boden einer Leberzirrhose. Als Tumormarker gilt das α-Fetoprotein. Bei bekannter Leberzirrhose sollen regelmäßige Screening-Untersuchungen unter Einschluss der Sonographie und der α-Fetoprotein-Bestimmung erfolgen. Chirurgische Therapie, entweder in Form von partieller Leberresektion oder Lebertransplantation, stellt die einzige Therapieoption mit der Möglichkeit eines Langzeitüberlebens dar. Bei Patienten mit einer Leberzirrhose beeinträchtigen die postoperative Leberinsuffizienz und hohe lokale Tumorrezidivraten die Ergebnisse der Resektion. Als geeignete Resektionskandidaten gelten Patienten ohne Leberzirrhose oder Zirrhosepatienten im Child-Pugh-Stadium A mit Tumoren kleiner als 5 cm. Für Patienten in höheren Zirrhosestadien mit Tumoren kleiner als 5 bis 7 cm bedeutet die Lebertransplantation die bessere therapeutische Option. Die Ergebnisse der Lebertransplantation werden durch die Wartezeit auf ein geeignetes Spenderorgan negativ beeinflusst. Die Lebendleberspende bietet eine neue Behandlungsmöglichkeit mit der Option der Verbesserung der Überlebensraten nach der Transplantation und der Erweiterung der Indikation zur Transplantation.
Abstract
Hepatocellular carcinoma (HCC) accounts for most primary malignancies of the liver. The most important risk factor is liver cirrhosis. HCC can be traced by the tumor marker α-fetoprotein. Patients with a known liver cirrhosis should regularly be screened, including sonography and α-fetoprotein evaluation. Surgical therapy - either partial liver resection or liver transplantation - is the only treatment that can potentially achieve long-term survival. The presence of liver cirrhosis is likely to induce postoperative liver insufficiency and is associated with higher local tumor recurrence rate. Patients without liver cirrhosis or Child-Pugh A patients with tumors smaller than 5 cm may be considered as the ideal target group for resection. For more advanced stages of cirrhosis and tumors of less than 5 cm up to 7 cm in size, liver transplantation offers a better prognosis. Long waiting time for a suitable organ negatively influences liver transplantation outcome. Living donor liver transplantation is a novel therapeutic option that improves posttransplant survival and extends the indication for transplantation in hepatocellular carcinoma.
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