Clinical characteristics and time trends in etiology of hepatocellular cancer in Germany

Digestion. 2013;87(3):147-59. doi: 10.1159/000346743. Epub 2013 Mar 29.


Introduction: The incidence of hepatocellular cancer (HCC) continues to rise in Europe with a shift of the primary cause towards alcoholic and non-alcoholic fatty liver disease. Metabolic factors like diabetes mellitus and overweight have been identified as significant risk factors for HCC development.

Patients and methods: A retrospective analysis in a large single-center cohort of 650 patients diagnosed with HCC was performed. Demographic characteristics, risk factors, tumor stage at diagnosis and survival were evaluated.

Results: Among 650 patients (aged 17-87 years, with a male: female ratio of 4:1), 80.8% had underlying liver cirrhosis. Alcohol abuse was identified as the only risk factor for liver cirrhosis in 52.2% of patients. Viral infection with hepatitis C and hepatitis B was present in 13.7 and 3.6% of patients, respectively. 66.1% of patients with HCC were overweight with a body mass index exceeding 25, 25.5% even exceeding 30; 52% of patients had diabetes mellitus.

Conclusion: Strategies aiming at prevention and surveillance of patients at risk to develop HCC in the future need to widen the focus from patients with chronic viral hepatitis and a history of alcohol abuse to patients with metabolic risk factors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / epidemiology*
  • Carcinoma, Hepatocellular / etiology
  • Carcinoma, Hepatocellular / pathology
  • Female
  • Germany / epidemiology
  • Hepatitis, Chronic / complications*
  • Humans
  • Liver / pathology*
  • Liver Cirrhosis, Alcoholic / complications*
  • Liver Neoplasms / epidemiology*
  • Liver Neoplasms / etiology
  • Liver Neoplasms / pathology
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Young Adult