Analysis of 6381 hepatocellular carcinoma patients in southern Taiwan: prognostic features, treatment outcome, and survival.
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.
Changchien
Chi-Sin
CS
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.
Chen
Chao-Long
CL
Yen
Yi-Hao
YH
Wang
Jing-Houng
JH
Hu
Tsung-Hui
TH
Lee
Chuan-Mo
CM
Wang
Chih-Chi
CC
Cheng
Yu-Fan
YF
Huang
Yu-Jie
YJ
Lin
Chih-Yun
CY
Lu
Sheng-Nan
SN
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