Aim: Cancer risk of cirrhotic patients seems to be increased compared to average population
due to several factors such as changes in hormonal levels or impaired metabolism of
carcinogens. However, major surgery and chemotherapy in subjects with liver dysfunction
are associated with increased mortality and morbidity limiting special oncological
therapy. Therefore, it was the aim of our present study to (1) investigate the prevalence
of extrahepatic cancer, (2) the risk of postinterventional death and longterm survival
after specific oncological treatment while evaluating (3) the predictors of survival
in a large cirrhotic population in Southern Germany.
Methods: The study population was assembled retrospectively from a database of hospitalized
patients (n=354) of our hospital who had the diagnosis of liver cirrhosis (LC) during
the 4-year period from January 2005 until May 2008. The study population was divided
into three subgroups: (I) patients with extrahepatic malignancies and a follow up
more than 12 months [n=26, „long-term survival-group“: mean survival time: 77.3 months
(24–168 months)], (II) patients with extrahepatic malignancies and a follow up shorter
than 12 months [n=28, „short-term survival-group“: mean survival time: 4.2 months
(0.1–12 months)], and (III) patients suffering from primary liver cancer [n=30, mean
survival time: 6,6 months (0.2–24 months)].
Results: Altogether, 84 neoplasms were observed in our cirrhotic population [19.8% (70/354)].
30 of those were hepatic [HCC 7.6% (27/354), CCC 0.8% (3/354)] and 54 were extrahepatic
malignancies (15.3%). We found a relatively large proportion of colorectal carcinoma,
prostate cancer and tobacco-related tumors such as lung cancer. When analysing the
performed oncological treatment, a large proportion of patients with short time survival
(n=13) received no specific therapy but only palliative treatment due to reduced physical
performance and noncompliance even in cases of limited disease. The rate of postinterventional
death after specific (mainly surgical) treatment within 30 days after procedure was
relatively low (n=8) and occurred mainly in patients with advanced chronic liver disease
and after surgical therapy. TNM stage was the best prognostic indicator of longterm
survival when using univariate (p<0.0001) and multivariate analysis (p=0.001).
The diagnostic capability of the MELD-Score in differentiation of long and short-time
survival using a ROC curve analysis was good (AUC=0.873). We found a significant influence
of low bilirubin (univariate analysis: p=0.01; multivariate analysis: p=0.014), normal
albumin (univariate analysis: p=0.005) and the occurrence of ascites (p<0.0001),
which represent parameters of Child's classification, on the survival probability.
Further prognostic information was provided by comparing the mean age of both subgroups
which was significantly lower in the „long-term survival-group“ (60.53yrs; p=0.032;
t-test) than in the „short-term survival group“ (68.25yrs).
Conclusion: In conclusion, our data confirm that cirrhotic patients have an increased risk to
develop extrahepatic cancer, especially CRC, prostate cancer and cancer related to
tobacco abuse. Patients with compensated cirrhosis (low MELD score; low serum bilirubin,
normal albumin, no ascites) have a significantly longer survival rate and a lower
perioperative mortality. Similar to patients without liver disease, an older age and
an extended TNM stage are associated with reduced longterm survival. The rate of patients
who received no specific therapy due to noncompliance and reduced physical condition
was relatively large emphasizing the importance of an individual decision concerning
the oncological management especially for patients with LC, independent from TNM classification.
