In addition, our study also indicated that ECOG PS 0/1 (p < 0.001), T stage 4A/4B (p = 0.016), lymph nodes metastases (p = 0.003), AJCC tumor stage IVA/B (p < 0.001), positive LVI (p = 0.001), positive PNI (p < 0.001), ENE (p < 0.001), P16 positive (p = 0.015), cigarette smoking (p = 0.029), betel nuts chewing (p = 0.006), viral hepatitis (p = 0.017), strong AT1R(p = 0.001, Fig. 1E), and strong MDK expression (p < 0.001, Fig. 1) were associated with inferior OS. Here, MDK is linked to animal viral hepatitis.