Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area

Background and Aim: To investigate the clinical characteristics and survival outcomes of a large cohort of hepatocellular carcinoma (HCC) patients treated at a single institute in a hepatitis B virus (HBV)-endemic area. Methods: Between 2000 and 2003, 904 patients with HCC treated at our institute were enrolled, and followed until 2005. Results: The mean age of the patients was 56 years and 76.3% were HBV-positive. The 1-, 2-, 3-, and 4-year survival rates were 53.8%, 40.0%, 31.4%, and 25.7%, respectively. The 4-year survival rates for Child-Pugh class A patients treated by resection or transarterial chemoembolization (TACE) were 77.3% and 63.2% for those with modified International Union Against Cancer (UICC) stage I or II disease (P = 0.043), and 58.6% and 19.2% for those with modified UICC stage III disease (P < 0.001). In patients with Child-Pugh class A and stage IVa, the median survival times differed between TACE and chemotherapy treatments (6.9 vs 4.0 months, P = 0.003), whereas in patients with stage IVb there was no difference between treatments (8.5 vs 6.1 months, P = 0.173) Serum alpha-fetoprotein level, presence of portal vein tumor thrombosis, Child-Pugh class, tumor, node, and metastasis stage, and the number and type of HCC were all related to prognosis. Significant differences in survival curves were observed among the Japanese Integrated Staging scores. Conclusions: The results of this study will be helpful in determining the survival outcomes and treatment strategies for HCC patients in HBV-endemic areas.