Is the prognosis of young patients with hepatocellular carcinoma poorer than the prognosis of older patients? A comparative analysis of clinical characteristics, prognostic features, and survival outcome

[Guest guest]

http://www.springerlink.com/content/j6m568326062vur4/

Is the prognosis of young patients with hepatocellular carcinoma poorer than the

prognosis of older patients? A comparative analysis of clinical characteristics,

prognostic features, and survival outcome

Journal Journal of Gastroenterology

Publisher Springer Japan

ISSN 0944-1174 (Print) 1435-5922 (Online)

Issue Volume 43, Number 11 / November, 2008

Category Liver, Pancreas, and Biliary Tract

DOI 10.1007/s00535-008-2238-x

Pages 881-888

Subject Collection Medicine

SpringerLink Date Monday, November 17, 2008

Liver, Pancreas, and Biliary Tract

Is the prognosis of young patients with hepatocellular carcinoma poorer than the

prognosis of older patients? A comparative analysis of clinical characteristics,

prognostic features, and survival outcome

Pik-Eu Chang1, Wai-Choung Ong1, Hock-Foong Lui1 and Chee-Kiat Tan1

(1) Department of Gastroenterology and Hepatology, Singapore General Hospital,

Outram Road, 169608 Singapore, Singapore

Received: 1 February 2008 Accepted: 16 June 2008 Published online: 18 November

2008

Abstract

Background Hepatocellular carcinoma (HCC) is uncommon in young adults. This

study examined the clinical characteristics and survival outcome of young HCC

patients compared with those in older patients.

Methods Data were prospectively collected from 638 patients diagnosed with HCC

over a 9-year period. Patients aged ¡Â40 years at diagnosis of HCC were defined

as young HCC patients. Their clinical characteristics and survival was compared

with those aged>40 years.

Results The prevalence of young HCC was 8.6% (55/638). Young HCC patients had a

significantly higher rate of hepatitis B-related disease (HBsAg positivity:

85.5% vs. 59.7%, P = 0.003), better Child-Pugh status (Child-Pugh class A: 69.1%

vs. 43.9%, P = 0.002), and lower rates of cirrhosis (12.7% vs. 34.3%, P = 0.001)

compared with the older group. They had more advanced disease at diagnosis, with

higher ¥á-fetoprotein levels (>12 000 ¥ìg/l: 45.4% vs. 30.5%, P = 0.026), a

higher incidence of portal vein involvement (63.6% vs. 40%, P = 0.003), and a

more advanced TNM stage (TNM IV: 83.6% vs. 66.4%, P = 0.018). More young

patients were eligible for surgical resection (18.2% vs. 8.2%, P = 0.014). The

overall survival between the two groups was similar, but when the patients were

stratified for stage of disease, the median survival of young patients with

early disease was superior to that of older patients (51.2 vs. 11.6 months, P =

0.025).

Conclusions HCC in young adults occurs mainly in hepatitis B carriers and is

often diagnosed at an advanced stage. Their survival outcome is not different

from that of older patients because the advanced disease at presentation offsets

the advantages of better liver function and a higher resection rate. However,

there is a distinct survival advantage for young patients diagnosed with early

disease. These results support the importance of extending HCC surveillance to

young hepatitis B carriers.

[Guest guest]

http://www.springerlink.com/content/j6m568326062vur4/

Is the prognosis of young patients with hepatocellular carcinoma poorer than the

prognosis of older patients? A comparative analysis of clinical characteristics,

prognostic features, and survival outcome

Journal Journal of Gastroenterology

Publisher Springer Japan

ISSN 0944-1174 (Print) 1435-5922 (Online)

Issue Volume 43, Number 11 / November, 2008

Category Liver, Pancreas, and Biliary Tract

DOI 10.1007/s00535-008-2238-x

Pages 881-888

Subject Collection Medicine

SpringerLink Date Monday, November 17, 2008

Liver, Pancreas, and Biliary Tract

Is the prognosis of young patients with hepatocellular carcinoma poorer than the

prognosis of older patients? A comparative analysis of clinical characteristics,

prognostic features, and survival outcome

Pik-Eu Chang1, Wai-Choung Ong1, Hock-Foong Lui1 and Chee-Kiat Tan1

(1) Department of Gastroenterology and Hepatology, Singapore General Hospital,

Outram Road, 169608 Singapore, Singapore

Received: 1 February 2008 Accepted: 16 June 2008 Published online: 18 November

2008

Abstract

Background Hepatocellular carcinoma (HCC) is uncommon in young adults. This

study examined the clinical characteristics and survival outcome of young HCC

patients compared with those in older patients.

Methods Data were prospectively collected from 638 patients diagnosed with HCC

over a 9-year period. Patients aged ¡Â40 years at diagnosis of HCC were defined

as young HCC patients. Their clinical characteristics and survival was compared

with those aged>40 years.

Results The prevalence of young HCC was 8.6% (55/638). Young HCC patients had a

significantly higher rate of hepatitis B-related disease (HBsAg positivity:

85.5% vs. 59.7%, P = 0.003), better Child-Pugh status (Child-Pugh class A: 69.1%

vs. 43.9%, P = 0.002), and lower rates of cirrhosis (12.7% vs. 34.3%, P = 0.001)

compared with the older group. They had more advanced disease at diagnosis, with

higher ¥á-fetoprotein levels (>12 000 ¥ìg/l: 45.4% vs. 30.5%, P = 0.026), a

higher incidence of portal vein involvement (63.6% vs. 40%, P = 0.003), and a

more advanced TNM stage (TNM IV: 83.6% vs. 66.4%, P = 0.018). More young

patients were eligible for surgical resection (18.2% vs. 8.2%, P = 0.014). The

overall survival between the two groups was similar, but when the patients were

stratified for stage of disease, the median survival of young patients with

early disease was superior to that of older patients (51.2 vs. 11.6 months, P =

0.025).

Conclusions HCC in young adults occurs mainly in hepatitis B carriers and is

often diagnosed at an advanced stage. Their survival outcome is not different

from that of older patients because the advanced disease at presentation offsets

the advantages of better liver function and a higher resection rate. However,

there is a distinct survival advantage for young patients diagnosed with early

disease. These results support the importance of extending HCC surveillance to

young hepatitis B carriers.