title: Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a case cohort study.
abstract: OBJECTIVE
  A total of 967 patients with unresectable and untransplantable, biopsy-proven hepatocellular carcinoma (HCC) were prospectively evaluated at baseline and followed up till death.
  
  
  METHODS
  Survival was the end-point for all analyses.
  
  
  RESULTS
  We found in our overall analysis, that male gender, ascites, cirrhosis, portal vein thrombosis (PVT), elevated alpha-fetoprotein (AFP) or bilirubin or alkaline phosphatases were each statistically significant adverse prognostic factors. Patients with normal AFP survived longer than those with elevated AFP, in the presence of PVT, large or bilobar tumors or cirrhosis. We used a bivariate analysis to separate patient subgroups based on poor liver function and aggressive tumor characteristics. In subgroup analysis based on these subsets, there was clear discrimination in survival between subsets; in addition both cirrhosis and presence of PVT were significant, independent but modest risk factors. The results of this large dataset show that amongst nonsurgical HCC patients, there are clear subsets with longer survival than other subsets.
  
  
  CONCLUSIONS
  This data also supports the concept of heterogeneity of HCC.
authors.affiliation: Liver Tumor Program of Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA. brian.carr@jefferson.edu
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
authors.forename: Shama C
authors.initials: SC
authors.lastname: Buch
authors.forename: Venkateswarlu
authors.initials: V
authors.lastname: Kondragunta
authors.forename: Petr
authors.initials: P
authors.lastname: Pancoska
authors.forename: Robert A
authors.initials: RA
authors.lastname: Branch
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis