title: Analysis of 6381 hepatocellular carcinoma patients in southern Taiwan: prognostic features, treatment outcome, and survival.
abstract: BACKGROUND
  This hospital-based analysis was conducted to identify prognostic factors of hepatocellular carcinoma (HCC) in a hepatitis B virus endemic area.
  
  
  METHODS
  A total of 6381 HCC cases, diagnosed from 1986 to 2002, were enrolled, and 2890 (42.3%) of them were not treated. Survival rates were analyzed by correlation with the national mortality databank. Missing data and correlations among prognostic factors were considered in the analysis.
  
  
  RESULTS
  The overall 1-year, 3-year, 5-year, and 7-year survival rates were 44.3%, 24.9%, 17.1%, and 13%, respectively. Multivariate analysis revealed that the independent factors influencing survival were the initial treatment modality, degree of liver function impairment, hepatitis B surface antigen positivity, tumor status, and alpha-fetoprotein. Besides these well-known prognostic factors, high alanine aminotransferase (ALT) levels and a high aspartate aminotransferase (AST)/ALT ratio were identified as independent poor prognostic factors.
  
  
  CONCLUSIONS
  This study, which considered untreated cases, missing data, and correlations between variables and official survival data sets, provides a large-scale comprehensive survival analysis. According to our results, high ALT and high AST/ALT were independent poor prognostic factors. Therefore, viral activity should be controlled in HCC patients, and patients with elevated AST/ALT ratios should be carefully monitored.
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University of Medicine, 123 Tapei Rd., Niaosung, 833, Kaohsiung, Taiwan.
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Yen
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Huang
authors.forename: Chih-Yun
authors.initials: CY
authors.lastname: Lin
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome