Hepatocellular carcinoma in Central Europe: prognostic features and survival

Abstract

Background and aims: We investigated the influence of baseline characteristics of patients with hepatocellular carcinoma (HCC) on prognosis and developed a multivariate Cox model predicting survival. All patients were from Central Europe.

Methods: All 245 patients seen at the Department of Gastroenterology and Hepatology at the University of Vienna, Austria, from July 1991 to March 1998 were included in this retrospective study. Nineteen different clinical characteristics and survival time from date of diagnosis were noted. Factors determining survival time were analysed by univariate and multivariate analysis using Cox proportional hazard regression models and a new classification model was constructed. The validity of this model was tested on an independent group of 89 patients, seen from April 1998 to September 1999.

Results: Median survival in patients with HCC was 8.0 months. In a multivariate analysis bilirubin (>2 mg/dl), portal vein thrombosis, prothrombin time (<70%), alpha fetoprotein (>180 microg/l), tumour mass >50%, and enlarged lymph nodes were independent predictors of survival. A newly constructed Cox proportional hazard model (Vienna survival model for HCC=VISUM-HCC) identified three disease stages with different durations of survival (median survival stage 1, 15.2 months; stage 2, 7.2 months; and stage 3, 2.6 months; p=0.00001). Applying the VISUM-HCC survival model to patients in Okuda stage 2 identified subgroups with an excellent and very poor prognosis for which different treatment modalities should be offered.

Conclusions: Our patients with HCC had a poor median survival of eight months. Six easily measurable clinical variables were significant predictors of survival in patients with HCC. The new VISUM-HCC survival model may be useful for stratifying patients with HCC for various clinical treatment modalities.

Figures

Figure 1

(A) Cumulative survival rate for all 245 patients included in the study. Median survival was 8.0 months. (B) Cumulative survival of patients with hepatocellular carcinoma with cirrhosis Child stage A (n=84), Child stage B (n=93), and Child stage C (n=35), and without liver cirrhosis (No LC) (n=33). Survival was significantly different between patients with and without cirrhosis (log rank test, p=0.00041).

Figure 2

(A) Cumulative survival of patients with hepatocellular carcinoma (HCC) (n=245) grouped according to Okuda stages: stage 1 (n=40), stage 2 (n=161), and stage 3 (n=44). Survival was statistically different between stages 2 and 3 (log rank test, p=0.0001) but not between stages 1 and 2 (log rank test, p=0.06331). (B) Cumulative survival rate of patients grouped according to the newly developed staging system VISUM-HCC, incorporating the six significant predictive variables (bilirubin >2 mg/dl, prothrombin time 50%, enlarged lymph nodes, α fetoprotein >125 kU/l), as determined by multivariate analysis.

Figure 3

Survival curves of patients stratified according to VISUM-HCC criteria between the model group (group A) and the testing group (group B); no significant difference was found.

Figure 4

(A) Okuda stage 2, (B) Okuda stage 2 grouped according to VISUM-HCC; significantly different survival rates were noted between stages 1, 2, and 3.