Skip to main content

Advertisement

SpringerLink
Log in

Analysis of 6381 hepatocellular carcinoma patients in southern Taiwan: prognostic features, treatment outcome, and survival

  • Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

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 α-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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Befeler AS, Di Bisceglie AM. Hepatocellular carcinoma: diagnosis and treatment. Gastroenterology 2002;122:1609–1619.

    Article  PubMed  Google Scholar 

  2. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding esophageal varices. Br J Surg 1973;60:646–664.

    Article  PubMed  CAS  Google Scholar 

  3. International Union Against Cancer (UICC). In: Sobin LH, Wittekind CH, editors. TNM classification of malignant tumours, 5th ed. New York: Wiley-Liss; 1997. p. 74–77.

    Google Scholar 

  4. Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985;56:918–928.

    Article  PubMed  CAS  Google Scholar 

  5. Attali P, Prod’Homme S, Pelletier G, Papoz L, Ink O, Buffet C, et al. Prognostic factors in patients with hepatocellular carcinoma. Attempts for the selection of patients with prolonged survival. Cancer 1987;59:2108–2111.

    Article  PubMed  CAS  Google Scholar 

  6. Chevret S, Trinchet JC, Mathieu D, Rached AA, Beaugrand M, Chastang C. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. J Hepatol 1999;31:133–141.

    Article  PubMed  CAS  Google Scholar 

  7. Stuart KE, Anand AJ, Jenkins RL. Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival. Cancer 1996;77:2217–2222.

    Article  PubMed  CAS  Google Scholar 

  8. Calvet X, Bruix J, Gines P, Bru C, Sole M, Vilana R, et al. Prognostic factors of hepatocellular carcinoma in the west: a multivariate analysis in 206 patients. Hepatology 1990;12:753–760.

    Article  PubMed  CAS  Google Scholar 

  9. Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999;29:62–67.

    Article  PubMed  CAS  Google Scholar 

  10. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. The Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 1998;28:751–755.

  11. Schoniger-Hekele M, Muller C, Kutilek M, Oesterreicher C, Ferenci P, Gangl A. Hepatocellular carcinoma in central Europe: prognostic features and survival. Gut 2001;48:103–109.

    Article  PubMed  CAS  Google Scholar 

  12. Leung TW, Tang AM, Zee B, Lau WY, Lai PB, Leung KL, et al. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer 2002;94:1760–1769.

    Article  PubMed  Google Scholar 

  13. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003;38:207–215.

    Article  PubMed  Google Scholar 

  14. Omagari K, Honda S, Kadokawa Y, Isomoto H, Takeshima F, Hayashida K, et al. Preliminary analysis of a newly proposed prognostic scoring system (SLiDe score) for hepatocellular carcinoma. J Gastroenterol Hepatol 2004;19:805–811.

    Article  PubMed  Google Scholar 

  15. Tateishi R, Yoshida H, Shiina S, Imamura H, Hasegawa K, Teratani T, et al. Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients. Gut 2005;54:419–425.

    Article  PubMed  CAS  Google Scholar 

  16. Sala M, Forner A, Varela M, Bruix J. Prognostic prediction in patients with hepatocellular carcinoma. Semin Liver Dis 2005;25:171–180.

    Article  PubMed  Google Scholar 

  17. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.

    Article  Google Scholar 

  18. Christensen E. Multivariate survival analysis using Cox’s regression model. Hepatology 1987;7:1346–1355.

    Article  PubMed  CAS  Google Scholar 

  19. Okita k. Clinical aspects of hepatocellular carcinoma in Japan. Intern Med 2006;45:229–233.

    Article  PubMed  Google Scholar 

  20. Wildi S, Pestalozzi BC, McCormack L, Clavien PA. Critical evaluation of the different staging systems for hepatocellular carcinoma. Br J Surg 2004;91:400–408.

    Article  PubMed  CAS  Google Scholar 

  21. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL Conference. J Hepatol 2001;35:421–430.

    Article  PubMed  CAS  Google Scholar 

  22. Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42:1208–1236.

    Article  PubMed  Google Scholar 

  23. Hsu HC, Wu TT, Wu MZ, Sheu JC, Lee CS, Chen DS. Tumor invasiveness and prognosis in resected hepatocellular carcinoma. Clinical and pathogenetic implications. Cancer 1988;61:2095–2099.

    Article  PubMed  CAS  Google Scholar 

  24. Yuen MF, Cheng CC, Lauder IJ, Lam SK, Ooi CG, Lai CL. Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience. Hepatology 2000;31:330–335.

    Article  PubMed  CAS  Google Scholar 

  25. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999;19:329–338.

    Article  PubMed  CAS  Google Scholar 

  26. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999;30:1434–1440.

    Article  PubMed  CAS  Google Scholar 

  27. Llovet JM. Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 2005;40:225–235.

    Article  PubMed  Google Scholar 

  28. Sakata H, Konishi M, Ryu M, Kinoshita T, Satake M, Moriyama N, et al. Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus. Hepatogastroenterology 2004;51:1575–1580.

    PubMed  Google Scholar 

  29. Itoshima T, Kawaguchi K, Ukida M, Ito T, Hattori S, Kitadai M, et al. Diagnosis of hepatocellular carcinoma in patients with liver cirrhosis using liver function assays. Acta Med Okayama 1984;38:159–168.

    PubMed  CAS  Google Scholar 

  30. Williams AL, Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology 1988;95:734–739.

    PubMed  CAS  Google Scholar 

  31. Nyblom H, Berggren U, Balldin J, Olsson R. High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking. Alcohol 2004;39:336–339.

    CAS  Google Scholar 

  32. Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006;295:65–73.

    Article  PubMed  CAS  Google Scholar 

  33. Niederau C, Heintges T, Lange S, Goldmann G, Niederau CM, Mohr L, et al. Long-term follow-up of HBeAg-positive patients treated with interferon alpha for chronic hepatitis B. N Engl J Med 1996;334:1422–1427.

    Article  PubMed  CAS  Google Scholar 

  34. Fattovich G, Giustina G, Degos F, Diodati G, Tremolada F, Nevens F, et al. Effectiveness of interferon alpha on incidence of hepatocellular carcinoma and decompensation in cirrhosis type C. European Concerted Action on Viral Hepatitis (EUROHEP). J Hepatol 1997;27:201–205.

    Article  PubMed  CAS  Google Scholar 

  35. Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531.

    Article  PubMed  CAS  Google Scholar 

  36. Camma C, Giunta M, Andreone P, Craxi A. Interferon and prevention of hepatocellular carcinoma in viral cirrhosis: an evidence-based approach. J Hepatol 2001;34:593–602.

    Article  PubMed  CAS  Google Scholar 

  37. Hung CH, Lee CM, Wang JH, Tung HD, Chen CH, Lu SN. Antiviral therapy after non-surgical tumor ablation in patients with hepatocellular carcinoma associated with hepatitis C virus. J Gastroenterol Hepatol 2005;20:1553–1559.

    Article  PubMed  CAS  Google Scholar 

  38. Hung CH, Lee CM, Lu SN, Wang JH, Hu TH, Tung HD, et al. Long-term effect of interferon alpha-2b plus ribavirin therapy on incidence of hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis. J Viral Hepat 2006;13:409–414.

    Article  PubMed  Google Scholar 

  39. Chen DS, Kuo GC, Sung JL, Lai MY, Sheu JC, Chen PJ, et al. Hepatitis C virus infection in an area hyperendemic for hepatitis B and chronic liver disease: the Taiwan experience. J Infect Dis 1990;162:817–822.

    PubMed  CAS  Google Scholar 

  40. Lu SN, Su WW, Yang SS, Chang TT, Cheng KS, Wu JC, et al. Secular trends and geographic variations of hepatitis B virus and hepatitis C virus-associated hepatocellular carcinoma in Taiwan. Int J Cancer 2006;15;119:1946–1952.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 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

    Chi-Sin Changchien, Yi-Hao Yen, Jing-Houng Wang, Tsung-Hui Hu, Chuan-Mo Lee, Chih-Yun Lin & Sheng-Nan Lu

  2. Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Chao-Long Chen & Chih-Chi Wang

  3. Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yu-Fan Cheng

  4. Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yu-Jie Huang

  5. Xiamen Chang Gung Hospital, Xiamen, China

    Sheng-Nan Lu

Authors
  1. Chi-Sin Changchien
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chao-Long Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi-Hao Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing-Houng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsung-Hui Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chuan-Mo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chih-Chi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yu-Fan Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yu-Jie Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chih-Yun Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sheng-Nan Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Changchien, CS., Chen, CL., Yen, YH. et al. Analysis of 6381 hepatocellular carcinoma patients in southern Taiwan: prognostic features, treatment outcome, and survival. J Gastroenterol 43, 159–170 (2008). https://doi.org/10.1007/s00535-007-2134-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-007-2134-9

Key words

Search

Navigation