Prognose des hepatozellulären Karzinoms nach neuen Stadieneinteilungen

Hintergrund und Fragestellung: In dieser Studie untersuchten wir die prognostischen Faktoren und das Überleben von Patienten mit hepatozellulärem Karzinom (HCC) in Norddeutschland. Dabei wurden die etablierten Staging-Systeme wie die Child-Pugh-, Okuda- und UICC-Klassifikation mit den neuen Scores aus Italien (CLIP) und Spanien (BCLC) verglichen.

Patienten und Methoden: In einer retrospektiven Studie untersuchten wir den Verlauf von 62 konsekutiven Patienten (34-82 Jahre, 48 männlich, 14 weiblich), bei denen an der Medizinischen Hochschule Hannover im Zeitraum von Oktober 1996 bis September 1998 ein hepatozelluläres Karzinom diagnostiziert wurde. Die Patienten wurden nach der Child-Pugh-, UICC-, Okuda-, CLIP- und BCLC-Klassifikation eingeteilt und bis zum 31.12.2001 nachbeobachtet.

Ergebnisse: Das mediane Überleben der Patienten lag bei 11,3 (1 - 59,5) Monaten. In der univariaten Analyse (Logrank-Test) waren fortgeschrittene Stadien der Okuda-, UICC-, CLIP- und BCLC-Klassifikation jeweils mit einer signifikant schlechteren Prognose verbunden, nicht jedoch bei der Child-Pugh-Klassifikation. In der multivariaten Analyse nach dem Cox-Regressionsmodell zeigten sich die CLIP-Klassifikation, die UICC-Klassifikation sowie eine chronische Hepatitis-B-Infektion als unabhängige Prognosefaktoren.

Folgerung: Die UICC- und die CLIP-Klassifikationen konnten die Patienten mit der besten Prognose identifizieren und waren in der multivariaten Analyse ein unabhängiger Faktor.

Background and objective: We investigated prognostic factors and survival of patients with hepatocellular carcinoma (HCC) in North-Germany. Established staging systems (Child-Pugh, Okuda and UICC classification) were compared with new prognostic scores from Italy (CLIP) and Spain (BCLC).

Patients and methods: The clinical course of 62 consecutive patients (34-82 years, 48 males, 14 females) with HCC observed in the Medical School of Hannover from October 1996 to September 1998 were retrospectively analyzed. The patients were classified according to the staging systems of Child Pugh, Okuda, UICC, CLIP and BCLC. Follow-up ended on December 31^st 2001.

Results: Overall median survival was 11,3 (1 - 59,5) months. At univariate analysis (log-rank test) Okuda, UICC, CLIP and BCLC Score were each associated with a shorter survival. In contrast Child Pugh score provided no significant prognostication. By multiple regression analysis (Cox regression analysis), only the CLIP and UICC score and chronic hepatitis B infection were shown to be independent risk factors.

Conclusion: Our investigations indicate, that the CLIP and UICC classifications identified those patients with the best prognosis and they, as well as chronic hepatitis C, were shown to be independent risk factors.

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