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[Prognosis of liver cirrhosis: results of a 14-year-long clinical follow-up study].

The incidence of primary liver cancer (PLC) was assessed in 652 patients (429 male, 223 female) with liver cirrhosis. By the end of the study 64% of all patients had died. The autopsy rate was 65%. 138 patients (49%) died after acute gastrointestinal hemorrhage. PLC developed in 73 patients (11.3%). Histologically 67 cases were classified as hepatocellular, one as mixed hepatocellular-cholangiocellular, and 5 as cholangiocellular carcinoma. In 32 cases PLC was confirmed within a year of diagnosis of cirrhosis, while in the remaining 41 cases PLC developed 2 to 13 years later. At autopsy the frequency of PLC was twice as high in males (30%) as in females (15%) (p less than 0.025). This difference occurred in alcoholic and posthepatic cirrhosis but not in cryptogenetic cirrhosis. HBsAg was detected in 18.5% of male and 8.9% of female patients (p less than 0.01). Comparison of patients with and without PLC revealed no significant differences in the prevalence of HBsAg. These data indicate that PLC is common in Austrian patients with cirrhosis and represents 64% of all malignant tumors in this group. In view of the high HBsAg carrier rate and the prevalence of chronic alcoholism in patients with cirrhosis, it is suggested that both factors together lead to an increased risk of cirrhosis followed by an increased incidence of PLC. Survival curves show that that the prognosis of severe liver cirrhosis is the same as that of patients with malignant diseases. Therefore, it is important to detect these patients at an early stage of the disease.