A total of 850 patients with hepatocellular carcinoma seen during the last 8 years were analyzed retrospectively for survival in relation to treatment and disease stage. A new staging scheme based on tumor size, ascites, jaundice and serum albumin was used. Clearly, the prognosis depended on disease stage. The median survival of 229 patients who received no specific treatment was 1.6 months, 0.7 month for Stage III patients, 2.0 months for Stage II, and 8.3 months for Stage I. The median survival of Stage I patients who had hepatic resection (n = 115) was 25.6 months and Stage II patients with resection (n = 42) was 12.2 months. In patients who had a small cancer (less than or equal to 25% of liver area in size) the median survival was 29.0 months. Survival of the surgically treated patients, which represented a highly selected group, was better than that of medically treated patients of a comparable stage. Median survival of Stage I medically treated patients (n = 124) was 9.4 months, for Stage II (n = 290) 3.5 months, and for Stage III (n = 50) 1.6 months. Medical treatment prolonged survival in Stage II and III patients, but not in Stage I. Transcatheter arterial embolization gave a better survival compared with chemotherapy, whether intra-arterial bolus administration of mitomycin C, systemic mitomycin C, or oral/rectal tegafur, in Stage II. Among various chemotherapeutic modalities, intra-arterial bolus injection was superior to systemic chemotherapy in survival in Stage II. In Stage III, chemotherapy improved survival as compared with no specific treatment. The major causes of death were hepatic failure and gastrointestinal bleeding, probably due to the coexistent advanced cirrhosis. These results in survival are much improved over the past reports, and the differences are probably a result of earlier diagnosis and frequent hepatic resections.

Background. In hepatocellular carcinoma (HCC), a high prevalence of hepatitis C virus antibody (anti‐HCV) has been reported, indicating that it may be an important etiologic factor in the pathogenesis of HCC. In this study, the authors investigated the prevalence of anti‐HCV in HCC patients, as well as the same prevalence in patients with cholangiocarcinoma (CC) and combined hepatocellular–cholangiocarcinoma (combined HCC‐CC), to study the clinicopathologic features of anti‐HCV–positive cases. Methods. The authors examined 141 patients with primary liver cancer who were pathologically diagnosed as having HCC (121 cases), CC (13 cases), or combined HCC‐CC (7 cases). Hepatitis B surface antigen (HBsAg) and anti‐HCV were measured in these patients. Results. Of 121 HCC cases, 85 (70.3%) were found to be anti‐HCV positive, 16 (13.2%) were HBsAg positive, and 5 (4.1%) were both anti‐HCV and HBsAg positive. In 13 cases with CC and in 7 with combined HCC‐CC examined, 4 (30.8%) and 5 (71.4%), respectively, were anti‐HCV positive. Conclusions. The anti‐HCV–positive rate was high in combined HCC‐CC as well as in HCC. These three types of primary liver cancer, which were anti‐HCV positive, shared two common features: male dominance and high incidences of complication with liver cirrhosis.

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We evaluated the relationship between the severity of thrombocytopenia and the serum hepatitis C virus (HCV) RNA level to investigate the mechanism of thrombocytopenia in patients with HCV infection. Patients who had chronic hepatitis without splenomegaly were divided into two groups according to the platelet count, which were 18 patients with a platelet count < or =150 x 10(9)/L and 22 patients with a platelet count >150 x 10(9)/L. HCV RNA, platelet-associated immunoglobulin G (PAIgG), rheumatoid factor (RF), and other immunological parameters were measured and correlations were investigated. Patients in the low platelet group had higher levels of PAIgG, Th1 cells, thrombopoietin (TPO), and RF than those in the normal platelet group (textitP < 0.05). Twenty-two patients completed 6 months of IFN therapy and were followed for more than 1 yr afterwards. Twelve patients who responded to IFN therapy with clearance of HCV showed an increase of the platelet count, whereas the 10 patients who did not respond to IFN showed a decrease of the platelet count. The improvement of thrombocytopenia after interferon therapy suggests a contribution of HCV infection to this condition.

Human telomerase reverse transcriptase (hTERT) has been identified as the catalytic subunit of human telomerase. To clarify the clinical significance of hTERT mRNA in hepatocellular carcinoma (HCC), we investigated the relationship between telomerase activity and hTERT mRNA in human HCC and non-HCC tissues. The hTERT mRNA was detected in 17 (89.47%) of 19 livers with HCC and in 4 (21.05%) of 19 noncancerous tissues from these livers. Telomerase activity was detected in 17 of the 19 tumor tissues (89.47%) and in 4 of the 19 nontumor tissues (21.05%). The hTERT mRNA was detected in all tissues that were telomerase-positive and it was undetected in all tissues that were telomerase-negative. The correlation between the expression of hTERT mRNA and human telomerase activity in this study indicates that hTERT mRNA could be useful to diagnose cancer. Also, as telomerase production may be under the control of hTERT mRNA, the possibility is great that noncancerous liver tissue with chronic liver diseases acquires HCC when the hTERT mRNA is positive.