requires hands-on training. Family planning organisations are keen to see more

requires hands-on training. Family planning organisations are keen to see more. Unlike most retrospective studies in the field of HCC that focus on the epidemiology and risk factors of HCC,[9],[10],[11],[12] the present study evaluates the 5-year survival rate of patients with HCC based on their clinical conditions and treatment methods. In the present study, the results of 227 HCC patients who referred to the Rasoul-e-Akram Hospital in Tehran from September 2007 to September 2017 showed that 5-year survival rate is 8.37%. This is consistent with the reported survival rate in similar studies that reported 5-year survival rate is 5%–14% for patients with HCC.[13],[14],[15] In our study, the 1-year survival rate (60.5%) and 3-year survival rate (27.6%) were assessed in patients with HCC. This results consist with the findings of Otto et al., who reported that the 1-year survival rate is 62% in patients with HCC,[16] and Bordoni et al., who reported that the 3-year survival rate is 19%.[17] In our study, tumor size >3 cm, metastasis to other organ, involved lymph nodes >2, and simultaneous infection with both types of hepatitis (HBV, HCV) are the risk factors of lower survival rate in patients with HCC, and combined surgical treatment and chemotherapy are related to higher survival rate. Many studies have investigated various risk factors that reduce the survival rate of patients with HCC. For example, the results of Wang et al.'s study in 2019 showed that race, age, region, tumor stage, and tumor grade are risk factors associated with decreasing the survival rate of patients with HCC.[18] Fujii et al. in 2012 showed that the risk factors for reducing HCC survival include age and tumor stage.[19] However, there are few studies that have examined the risk factors mentioned in our study. Wu et al. in 2019 showed that primary liver tumor size, lymph node involvement, and metastasis are the most important risk factors associated with decreasing the survival rate of patients with HCC.[20] The results of our study are also consistent with the study by Wu et al. Our study results show that, in addition to the risk factors mentioned above, HCV and HBV coinfections are a risk factor for the survival rate of patients with HCC. One of the differences between the results of our study and Wang et al. 2019 is that in our study, age is not a risk factor for HCC survival rate. The reason for this can be related to the race of our population study (Asian race). In Asia, the death rate due to HCC is lower.[18],[21].

Obesity (BMI >30 kg/m2) . there isn’t much consistency. A ferritin of

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