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Der Klinikarzt 2014; 43(5): 244-249
DOI: 10.1055/s-0034-1382805
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© Georg Thieme Verlag Stuttgart · New York

Interdisziplinäre Therapie des hepatozellulären Karzinoms – Stadiengerechte Ansätze von potenziell kurativ bis palliativ

Interdisciplinary therapy for hepatocellular carcinoma –Stage-adapted therapy options from potentially curative to palliative
Marcus Schuchmann
1   Zentrum für Innere Medizin, Klinikum Konstanz, Konstanz
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Publication Date:
03 June 2014 (online)

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Ein hepatozelluläres Karzinom (HCC) entwickelt sich bei uns in über 80 % der Fälle auf dem Boden einer Leberzirrhose. Das gleichzeitige Vorliegen von Tumorerkrankung und Zirrhose macht die Behandlung besonders herausfordernd und kompliziert. Als schwerwiegende Komplikation der Leberzirrhose gilt das HCC mittlerweile weltweit als die fünfthäufigste tumorassoziierte Todesursache. Zur noch weiter steigender Inzidenz des Tumors in den nächsten Jahren wird insbesondere die große Zahl der Patienten mit HCV-assoziierter Leberzirrhose beitragen.

Trotz guter Evidenz, für ein regelmäßiges Screening von Patienten mit Leberzirrhose gelingt es leider nur bei einem Fünftel der Patienten, den Tumor in einem so frühen Stadium zu entdecken, dass noch ein kurativer Therapieansatz möglich ist.

Erfolgt die Diagnosestellung, ist es für die betroffenen Patienten entscheidend, dass initial die richtige Therapieentscheidung getroffen wird: Hierzu ist eine interdisziplinäre Betrachtung unter Berücksichtigung der potenziell kurativen (Resektion, Lebertransplantation, lokale Ablation) und palliativen (transarterielle Verfahren, Sorafenib) Therapieansätze von zentraler Bedeutung.

Um in Zukunft erfolgreicher gegen das HCC vorzugehen, wird es vor allem einer umfassenderen und breiter eingesetzten Primärprävention bedürfen – u.a. durch eine flächendeckende Impfung gegen HBV. Die konsequente Überwachung von Patienten mit Leberzirrhose, sowie – nach Diagnosestellung –multimodale Therapiekonzepte sollten für alle niedrigschwellig zugänglich gemacht werden.

Hepatocellular carcinoma (HCC) in Europe generally develops in over 80 % of the cases on the basis of liver cirrhosis. The simultaneous presence of tumor disease and cirrhosis makes therapy particularly challenging and complicated. As an especially severe complication of liver cirrhosis HCC is now considered worldwide to be the fifth most frequent cause of tumor-associated death. In particular, the large number of patients with HCV-associated liver cirrhosis will lead to a further increase in the incidence of this tumor in the next few years.

In spite of solid evidence for a regular screening of patients with liver cirrhosis, unfortunately it is only possible in about one-fifth of the patients to detect the tumor in such an early stage that curative therapy is possible.

Once the diagnosis has been made it is of decisive importance for the patient that initially an appropriate and correct therapy be chosen. For this an interdisciplinary assessment under consideration of the potentially curative (resection, liver transplantation, local ablation) and palliative (transarterial procedures, sorafenib) therapeutic options is a central significance.

In order to improve the management of HCC in the future a more comprehensive and broader usage of primary prevention will be necessary – including among others, generalized vaccination against HBV. The consequent screening of patients with liver cirrhosis as well as, after a positive diagnosis, multimodal therapeutic options should be readily and easily available for all such patients.

Key words

Hepatocellular carcinoma (HCC) - interdisciplinary therapy - liver cirrhosis - hepatitis B virus - liver transplantation
 

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