Background Hypoxia inducible factor 1α (HIF-1α) is a protein related with carcinogenesis and metastasis in many tumors. However, little is known about the prognostic value of HIF-1α in hepatocellular carcinoma (HCC) patients with cirrhosis. Methods Clinical-pathological information and follow-up data were collected from HCC (n = 419) and chronic hepatitis (n = 49) patients. HIF-1α expression was scored based on the percentage of immunohistochemical staining. Correlations between HIF-1α expression and clinical features were evaluated by Chi-square test. And survival analysis was performed by multivariate Cox regression analysis. Results In cirrhosis patients, the frequency of HIF-1α positive expression in HCC was higher than in chronic hepatitis (P = 0.002). HIF-1α positive expression was significantly associated with vascular invasion (P = 0.002), TNM stage (P = 0.005), HBV infection (P = 0.005), tumor size (P = 0.025) and portal vein tumor thrombus (P = 0.001) in HCC with liver cirrhosis. While, in cirrhosis-free patients, HIF-1α positive expression had a significant correlation with vascular invasion (P = 0.039) and AFP value (P = 0.001) in. HIF-1α “positive” had decreased overall survival compared to HIF-1α “negative” patients and this was an independent adverse prognostic factor (multivariable analysis P = 0.001) for HCC patients with cirrhosis, but not for cirrhosis-free patients. Conclusions Our results suggested that HIF-1α served as a poor prognostic factor for HCC patients with cirrhosis.
