Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Association between body mass index and the risk of falls: a nationwide population-based study

The association of BMI with falls differed between men and women in Korea. Obesity was associated with a greater risk of falls in women, whereas underweight seemed to increase the risk of falls compared with normal weight in men.

PURPOSE

This study examined the sex-specific association between body mass index (BMI) and falls in Korean adults using data from a large population-based survey.

METHODS

We analyzed 113,805 men and women (age ≥ 50 years) who participated in the Korean Community Health Survey in 2013. Logistic regression was used to assess the relationship between BMI and falls.

RESULTS

The mean (± standard deviation) age and BMI of all participants were 63.8 ± 9.6 years and 23.2 ± 2.9 kg/m², respectively. Among the 113,805 subjects, 19.1% and 6.7% had histories of falls and recurrent falls, respectively. The association of BMI with recurrent falls differed between men and women. The multivariable-adjusted odd ratios (ORs) for recurrent falls were 0.98 (95% confidence interval [CI] 0.86-1.12), 1.23 (1.14-1.32), and 1.51 (1.26-1.81) in women with BMIs of < 18.5, 25-29.9, and ≥ 30 kg/m², respectively, relative to those with BMIs of 18.5-24.9 kg/m². The corresponding ORs for men were 1.20 (95% CI 1.01-1.42), 1.05 (0.96-1.14), and 0.97 (0.69-1.38), respectively. Older age and low economic level were associated independently with higher ORs of recurrent falls in men and women, respectively. In addition, comorbidities, including diabetes, stroke, arthritis, osteoporosis, and asthma, correlated significantly with an increased risk of recurrent falls (all p < 0.001).

CONCLUSIONS

Obesity was associated with a greater risk of recurrent falls in women, whereas underweight seemed to be associated with a greater risk of falls in men.

Low normal fasting glucose and risk of accidental death in Korean adults: A prospective cohort study

AIM

This study aimed to prospectively examine whether low normal glucose levels and hypoglycaemia are associated with increased mortality due to external causes, especially unintentional accidents.

METHODS

A total of 345,318 normoglycaemic Korean adults who had undergone health examinations during 2002-2003 were followed-up to 2013. To avoid potential biases related to glucose-lowering medication use, those with known diabetes or hyperglycaemia were excluded.

RESULTS

During 3.6 million person-years of follow-up, 1293 participants died because of unintentional accidents. Hazard ratios (HRs) for these accidental deaths were 1.26 (95% CI: 1.11-1.42), 1.60 (1.21-2.11) and 3.07 (1.37-6.85) for fasting serum glucose (FSG) levels of 70-79, 55-69 and <55mg/dL (3.9-4.4, 3.05-3.83 and <3.05mmol/L), respectively, compared with 80-99mg/dL (4.44-5.5mmol/L). FSG levels<80mg/dL were associated with an approximately 30% higher mortality due to accidents: specifically, 40% were non-fall-related injury; 50% were automobile-related; and 80% were motorcycle-related. The associations were weak (approximately 10% higher mortality, with P>0.05 for each cause) for deaths due to traffic accidents (pedestrians, pedal cyclists), falls, intentional self-harm and physical assault. The population attributable risks for FSG levels <80mg/dL were 10% (95% CI: 2-18%) for non-fall-related injury, 11% (6-17%) for car accidents and 17% (6-27%) for motorcycle accidents.

CONCLUSION

FSG levels of 70-79mg/dL (3.9-4.4mmol/L) as well as <70mg/dL are risk factors for accidental death. Appropriate management of the impact of FSG levels <80mg/dL might reduce unintended deaths due to non-fall-related injury, and automobile and motorcycle accidents, by ≥10%.

Variations in fat mass contribution to bone mineral density by gender, age, and body mass index: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011

The relationship of body composition and bone mineral density is complex and controversial. When classifying Korean population based on gender, age, and body mass index, fat mass had varying contributions to bone mineral density.

INTRODUCTION

The relationship between body composition and bone mineral density (BMD) is complex, and it is uncertain how components of body mass variably affect BMD.

METHODS

This cross-sectional observational study was performed in subjects ≥20 years based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2008 to 2011. Among 17,583 subjects, the mean ages were 49.1 ± 16.0 years (M, n = 7495) and 49.3 ± 16.3 years (F, n = 10,088). Subjects were divided into age groups, either <50 or ≥50 years for males, or menopausal state, either premenopausal or postmenopausal, for females. A further classification used BMI, either <25 or ≥25 kg/m(2). Anthropometric and body composition parameters were compared and evaluated to look for correlations with BMD. Further, appendicular lean mass (ALM), fat mass (FM), fat percentage (FP), and waist circumference (WC) were included for multivariate analysis with BMD, controlling for covariates in each age group and BMI subgroup.

RESULTS

Anthropometric and body composition parameters significantly correlated with BMD in all age groups for both genders. After adjusting for covariates, ALM strongly affected BMD in all age groups for both genders. FM, FP, and WC significantly affected BMD in both age groups of women and in older men, but they did not affect BMD in younger men. Fat indices positively affected BMD of all sites in all non-obese women and in non-obese older men. However, little contribution was found in obese subgroups of both genders and in non-obese younger men.

CONCLUSION

Considering different weights of covariates, ALM strongly contributed to BMD in all gender, age, and BMI groups. On the other hand, fat indices positively affected BMD of both age groups in women and older men with normal BMI, but they showed little contribution to BMD within the same age groups with high BMI or any BMI subgroups of younger men.

Trends in the incidence of and survival rates for oral cavity cancer in the Korean population

OBJECTIVE

This study assessed trends in the incidence of and survival rates for oral cavity cancer in the Korean population.

MATERIALS AND METHODS

Data from the Korea Central Cancer Registry were extracted for 10,282 patients diagnosed with oral cavity cancer (C01-C06) between 1999 and 2010 to evaluate the age-standardised incidence rate, annual percentage change (APC) and 5-year relative survival rate (RSR) according to gender and age.

RESULTS

In males, the incidence rate slightly decreased [APC of -0.2% (P = 0.6427)]; in females, the incidence rate increased [APC of 3.1% (P < 0.05)]. In males and females, the incidence of oral tongue cancer (C02) significantly increased [APC of 2.2% and 4.1%, respectively (P < 0.05)]. This increase in oral tongue cancer incidence was most prominent in the younger age group (<40 years, APC = 6.1%, P < 0.05). The incidence of buccal cheek cancer increased only among males [APC of 4.8% (P < 0.05)]. The 5-year RSR improved from 42.7% (1993-1995) to 59.5% (2006-2010), corresponding to an increase of 16.8% from 1993 to 2010 (P < 0.05).

CONCLUSION

The incidence of oral cavity cancer in females increased, whereas it stabilised or decreased in males. However, the incidence of oral tongue cancer increased in both males and females, especially in the younger age group.

The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery

BACKGROUND

We conducted a population-based retrospective cohort study to investigate the influence of hospital volume, delay of surgery, and both together on the long-term survival of postoperative cancer patients.

METHODS

Using information from the Korea Central Cancer Registry from 2001 through 2005 and the National Health Insurance claim database, we determined survival for 147 682 patients who underwent definitive surgery for any of six cancers.

RESULTS

Regardless of cancer site, surgical patients in low- to medium-volume hospitals showed significantly worse survival [adjusted hazard ratio (aHR) = 1.36-1.86] than those in high-volume hospitals in multivariable analyses. Among the latter, treatment delays > 1 month were not associated with worse survival for stomach, colon, pancreatic, or lung cancer but were for rectal [aHR = 1.28; 95% confidence interval (CI), 1.17-1.40] and breast (aHR = 1.59; 95% CI, 1.37-1.84) cancer. For patients in low- to medium-volume hospitals, treatment delay was associated with worse survival for all types of cancer (aHR = 1.78-3.81).

CONCLUSION

Our findings suggest that the effect of hospital volume and surgical treatment delay on overall survival of cancer patients should be considered in formulating or revising national health policy.

The Incidence of Postoperative Nausea and Vomiting after Thyroidectomy using Three Anaesthetic Techniques

The choice of anaesthetics can affect the incidence of postoperative nausea and vomiting (PONV). This study compared the incidence of PONV in 177 female patients who underwent thyroidectomy, with anaesthesia induced and maintained using one of three regimens: (i) sevoflurane (thiopental sodium 4–5 mg/kg and sevoflurane 2.0–2.5 vol% in 50% air); (ii) total intravenous anaesthesia (TIVA; propofol-remifentanil [target blood concentrations 2.5–3.5 μg/ml and 3.5–4.5 ng/ml, respectively]); or (iii) combined inhalation and intravenous anaesthesia (sevoflurane 1.0 vol% in 50% air plus propofol-remifentanil [target blood concentrations 1.5–2.5 μg/ml and 2.5–3.5 ng/ml, respectively]). The incidence and severity of PONV and the need for rescue antiemetics were assessed at 0–24 h postoperatively. Overall, the incidence of PONV was significantly lower in the TIVA and combined groups compared with the sevoflurane group (33.9%, 39.0% and 64.4%, respectively). In conclusion, the maintenance of anaesthesia with propofol-remifentanil or sevoflurane-propofol-remifentanil decreased the incidence of PONV compared with sevoflurane alone.

Cancer survival in Busan, Republic of Korea, 1996-2001

The Busan cancer registry was established in 1996; cancer registration is done by passive and active methods. The registry contributed survival data for 48 cancer sites or types registered during 1996-2001. Follow-up information has been gleaned predominantly by passive methods with median follow-up ranging between 1-57 months for various cancers. The proportion with histologically verified diagnosis for different cancers ranged between 20-100%; death certificates only (DCOs) comprised 0-53%; 47-100% of total registered cases were included for survival analysis. The top-ranking cancers on 5-year age-standardized relative survival rates were penis (94%), thyroid (91%), non-melanoma skin (89%), placenta (86%), breast (76%), Hodgkin lymphoma (75%) and testis (72%). Five-year relative survival by age group showed a decreasing trend with increasing age groups for cancers of the nasopharynx, gall bladder, lung, bone, soft tissue, breast, cervix, corpus uteri, thyroid, multiple myeloma, lymphoid leukaemia and myeloid leukaemia or was fluctuating for other cancers.

Smoking, alcohol and gastric cancer risk in Korean men: the National Health Insurance Corporation Study

We investigated the risk of gastric cancer by subsite in relation to cigarette smoking and alcohol in a large population-based cohort of 669 570 Korean men in an insurance plan followed for an average 6.5 years, yielding 3452 new cases of gastric cancer, of which 127 were cardia and upper-third gastric cancer, 2409 were distal gastric cancer and 1007 were unclassified. A moderate association was found between smoking, cardia and upper-third (adjusted relative risk (aRR) 2.2; 95% confidence interval (CI) 1.4-3.5) and distal cancers (aRR=1.4; 95% CI=1.3-1.6). We also found a positive association between alcohol consumption and distal (aRR=1.3; 95% CI=1.2-1.5) and total (aRR=1.2; 95% CI=1.1-1.4) gastric cancer. Combined exposure to high levels of tobacco and alcohol increased the risk estimates further; cardia and upper-third gastric cancers were more strongly related to smoking status than distal gastric cancer.British Journal of Cancer (2007) 97, 700-704. doi:10.1038/sj.bjc.6603893 www.bjcancer.com Published online 17 July 2007.

Ovarian cancer incidence and survival in Korea: 1993-2002

This study examined incidence rates, histologic and stage distribution, and long-term survival rates of patients with ovarian cancer in Korea. A total of 11,404 patients diagnosed with ovarian cancer between 1993 and 2002 were reported to the Korea Central Cancer Registry and the Gynecologic Oncology Committee of Korean Society of Obstetrics and Gynecology. All rates were expressed per 100,000. The age-standardized incidence rates were 3.79 and 4.74 per 100,000 women in 1993 and 2002, respectively. The incidence rates of ovary cancer increased with age in Korea, and over half of the patients were in the stage IA (24.8%) and IIIC (26.8%) in this study. The 5-year relative survival rate was 59.6%. Relative survivals according to the stage of FIGO at 5 years were 91.1%, 75.2%, 46.4%, and 21.2% for stages I, II, III, and IV, respectively. The 5-year relative survivals of germ cell tumors and epithelial ovarian cancer were 89.0% and 58.3%, respectively. Surgical stage and histology were the most important prognostic factors of ovarian cancer. However, the 5-year survival rate of FIGO stage IC was significantly higher than that of stage IB.

Cervical cancer incidence and survival in Korea: 1993-2002

This study examined the incidence rates, histologic and stage distribution, and long-term survival rates of patients with cervical cancer in Korea. A total of 44,182 patients diagnosed with cervical cancer between 1993 and 2002 were reported to the Korea Central Cancer Registry and the Gynecologic Oncology Committee of Korean Society of Obstetrics and Gynecology. The age-standardized incidence rates were 19.0, 17.8, and 15.1 per 100,000 women in 1993-1995, 1996-1998, and 1999-2002, respectively. The incidence rates of adenocarcinoma (AC) have been in the range between 1.2 in 1993-1995 and 1.4 in 1999-2002, while those of squamous cell carcinoma declined from 15.1 in 1993-1995 to 12.2 in 1999-2002. The 5-year relative survival rate was 79.2%. Relative survival rates, according to stage by the FIGO, at 5 years were 94.2%, 69.7%, 38.9%, and 21.1% for stages I, II, III, and IV respectively. Relative survivals improved between 1993 and 1997, probably due to the introduction of cervical cancer screening and effective treatment. The incidence rates of AC have been constant despite decreased cervical cancer in Korea. Introduction of cervical cancer screening and effective treatment may have contributed to the improved relative survival.

Upregulation of c-Kit receptor and stem cell factor in cerebellar inhibitory synapses in response to kainic acid

Neuronal stimulation was induced in rats by systemic administration of kainic acid (KA) to determine if such stimulation is responsible for changes in the expression patterns of c-Kit and stem cell factor (SCF) in cerebellar synapses between inhibitory interneurons and Purkinje cells. Using immunocytochemistry and immunoblotting analyses, we demonstrate that c-Kit receptor tyrosine kinase and its ligand SCF are present on the pre- and postsynaptic sides of inhibitory synapses on Purkinje cells. These proteins are upregulated during the first 48 hr after KA treatment, whereas their levels fall below that of the control by 1 week and remain as such thereafter. Expression of both c-Kit and SCF are significantly elevated in the Purkinje cell layer 24 hr after KA administration, and the Purkinje cell layer exhibits a loss of calbindin D-28K immunoreactivity. Expression of c-Kit in basket cell axon terminals is activated until 48 hr after KA treatment, suggesting the transient participation of c-Kit receptor tyrosine kinase in the maintenance of these axonal terminals. Also during the first 48 hr after KA treatment, SCF levels increase in axonal processes of Purkinje cells, and these SCF-positive axons correlate with c-Kit-positive pinceau structures. The increased expression of c-Kit and SCF in response to KA-induced neuronal stimulation may indicate that c-Kit receptor tyrosine kinase and its ligand SCF function in the inhibitory synapse between cerebellar interneurons and Purkinje cells, and that this role is most pronounced during the first 48 hr after KA treatment.

A PCR analysis of ERalpha and ERbeta mRNA abundance in rats and the effect of ovariectomy

To study the relative abundance and the changes of both estrogen receptor alpha (ERalpha) and ERbeta mRNA before and after ovariectomy in major organs important to the regulation of calcium homeostasis, we compared the degree of mRNA expression of ERalpha to that of ERbeta in rat tissues by performing competitive reverse transcription polymerase chain reaction (RT-PCR) with internal standards. Both ERalpha and ERbeta were highly expressed in the ovary {ERalpha[(2.2 +/- 0.33) x 10(7) copies/microg of total RNA] > ERbeta[(1.2 +/- 0.33) x 10(5) copies/microg of total RNA]} as we expected. The bone marrow and renal cortex were very important target organs of estrogen because ERalpha was highly expressed approximately 2 x 10(5) copies/microg of total RNA, but marrow cells revealed only a very weak expression of ERbeta [(0.7 +/- 0.21) x 10(2) copies/microg of total RNA]. Both ERalpha and ERbeta were expressed in the trabecular bone [(3.2 +/- 0.56) x 10(3) copy/microg of RNA] and [(2.8 +/- 0.21) x 102 copy/microg of RNA], respectively. However, they were not detected in the cortical bone. In the jejunum, the expression of ERalpha was not detectable, while ERbeta was expressed very weakly [(1.1 +/- 0.24) x 10(2) copies/microg of total RNA]. The thyroid gland expressed low copy numbers of ERbeta [(6.0 +/- 0.23) x 10(2) copies/microg of total RNA], but the parathyroid gland was negative for both ERalpha and ERbeta mRNA. In cultured stromal cells, ERalpha and ERbeta mRNAs were not detected after a 24-h culture; however, the rates of mRNA expression of ERalpha and ERbeta reached approximately 105 copies/microg of total RNA and approximately 10(2) copies/microg of total RNA, respectively, after 9-, 11-, and 13-day cultures. After ovariectomy, the expression of ERalpha mRNA decreased abruptly in the bone marrow and renal cortex, and both ERalpha and ERbeta were barely detected in the trabecular bone. In conclusion, ERalpha might be the main ER in organs important for calcium homeostasis, except in the jejunum. The mRNA expression of ERalpha in the bone marrow and renal cortex decreased abruptly after ovariectomy, which may partially explain why the effect of estrogen deficiency can be amplified and why trabecular bone loss is more predominant than cortical bone loss shortly after surgical or natural menopause.

Intermittent parathyroid hormone treatment can promote linear growth in the ovariectomized growing rat

To compare the effect of intermittent parathyroid hormone (PTH) treatment with that of estrogen treatment on epiphyseal growth in ovariectomized rats, 46 Sprague-Dawley female rats aged 9-10 weeks (about 200-220 g) were either ovariectomized or sham operated. From 6 weeks after ovariectomy (ovx), rats were daily injected with subcutaneous human recombinant PTH (1-84)-dosed 30 micrograms/kg (the low dose PTH-treated group) or 300 micrograms/kg (the high dose PTH-treated group), 17 beta-estradiol (the 17 beta-estradiol-treated group, 30 micrograms/kg) or vehicle (the ovx-alone group), 5 times a week for 4 weeks. The decalcified sections of the distal femoral epiphyseal plate were analyzed on light microscopy after H&E stain, and the lengths of the zones of proliferation, maturing and hypertrophic chondrocytes were measured. The length of the growth plate, the zone of proliferation and the zone of hypertrophic chondrocyte in the ovx-alone group were significantly shorter than those of the sham-operated group. The treatment of 17 beta-estradiol speeded up the differentiation of cells from proliferating chondrocytes to maturing and hypertrophic chondrocytes even though the length of the growth plate was comparable to that of the sham-operated group. Both low and high dose PTH treatments increased the length of the growth plate, and those lengths were comparable to that of the sham-operated group. The fractions of proliferating, maturing and hypertrophic zone in the low dose PTH-treated group were also comparable to those of the sham-operated group. However, high dose PTH treatment slowed down the differentiation of cells from proliferating chondrocytes to maturing and hypertrophic chondrocytes to a greater extent, and therefore the fraction of proliferating chondrocytes of the high dose PTH-treated group was larger than that of the low dose PTH-treated group (73.8 +/- 1.8 Vs 63.3 +/- 1.3%, p < 0.005). From these results, we showed that intermittent PTH treatment could promote linear growth in the ovariectomized growing rat. We propose that PTH may be an alternative drug candidate for promoting linear growth of long bones without the risk for early closure of the growth plate.

Germline mutations of the APC gene in Korean familial adenomatous polyposis patients

We extensively analyzed genomic DNA and messenger RNA (mRNA) from 62 unrelated Korean patients with familial adenomatous polyposis (FAP) for identification of germline adenomatous polyposis coli (APC) gene mutations. We adopted both single-strand conformation polymorphism (SSCP) analysis and a method of analysis involving the reverse transcription-polymerase chain reaction (RT-PCR) followed by a protein truncation test (PTT). DNA sequencing confirmed all alterations represented by aberrant bands. Germline mutations were identified in 38 patients (61%). Nineteen of the detected mutations were presumed to be novel, thus emphasizing the heterogeneity of the mutational spectrum in Korean FAP patients. In the initial 48 patients, SSCP analysis was followed by PTT for those patients for whom no detectable mutations were found by SSCP. Using this combined approach, we identified germline APC gene mutations in 29 of the 48 FAP patients (60%), including 6 patients in whom SSCP analysis failed to distinguish the mutant allele. In the 14 later patients, we identified truncating mutations in 9 patients (64%) using PTT only. Our results confirm that the mutation detection rate with PTT was superior to that with SSCP, and suggest that PTT would be a more practical screening method to detect germline mutations of the APC gene in FAP patients.

Altered hydroxylation of estrogen in patients with postmenopausal osteopenia

To study the possible contributions of the differences in estrogen metabolism to bone mass in postmenopausal osteopenia, spinal and femoral bone mineral densities (BMD) were measured, and 18 urinary metabolites of estrogen were analyzed by a gas chromatography-mass spectrometry assay system in 59 postmenopausal women (5-10 yr after menopause). The BMD of the spine and femoral neck showed positive correlations with body weight, height, and body mass index as we expected. Compared to nonosteopenic subjects, there were no significant differences in serum estrone (E1) and estradiol (E2) levels in patients with osteopenia. However, the urinary 16 alpha-hydroxyestrone [16 alpha-(OH)E1] level was significantly lower in patients with spinal osteopenia (P < 0.001). Among the 18 urinary metabolites of estrogen, the 16 alpha-(OH)E1 and 16 alpha-(OH)E1/2-hydroxyestrone [2-(OH)E1) ratio showed positive correlations with spinal BMD (P < 0.05), whereas 2-(OH)E2 showed a negative correlation with femoral neck BMD (P < 0.05). The urinary 16 alpha-(OH)E1 level also revealed a positive correlation with the age-matched z score of BMD in the spine (P < 0.05). In multiple stepwise regression analysis, weight, 16 alpha-(OH)E1, interaction between 16 alpha-(OH)E1 and 2-(OH)E2, 2-(OH)E2, and years after menopause were statistically significant for spinal BMD (r2 = 0.4968). For femoral neck BMD and weight, 16 alpha-(OH)E1 and 2-(OH)E2 were the independent determinants (r2 = 0.3369). In conclusion, the activity of estrogen 16 alpha-hydroxylase was decreased and/or the activity of estrogen 2-hydroxylase was enhanced in post-menopausal osteopenia. We speculated that these derangements may serve as contributing factors for the acceleration of bone loss in post-menopausal osteoporosis.

Mutation of p53 gene in hepatocellular carcinoma cell lines with HBX DNA

It has been known that the incidence of p53 mutation is very rare in HBX-positive primary human hepatocellular carcinoma (HCC) tissues. The frequency of p53 mutation, however, in established cell lines with integrated HBV DNA and/or HBX has not been well studied. To know p53 mutational frequency, and to investigate whether the presence of HBX DNA sequence correlates with the absence of p53 mutation in the established HCC cell lines, we studied the p53 mutation and the presence of HBX sequence in 12 recently characterized HCC cell lines. As a result, all 12 (100%) lines showed mutation in the p53 gene. Three (25%) cell lines had transversion of codon 215 while no mutation of codon 249 was found. In contrast with previous reports, although HBX DNA was present in 11 cell lines, p53 mutation had occurred, indicating that the presence of HBX viral DNA does not correlate with a lack of p53 mutation in established HCC cell lines. Our results suggest that the frequency of p53 mutation is extremely high even in HBX DNA positive HCC cell lines.