Clinicopathological characteristics and prognostic factors in young patients after hepatectomy for hepatocellular carcinoma

Abstract

BackgroundThe aim of this study was to analyze the clinicopathological characteristics and the prognostic factors for survival and recurrence of young patients who had undergone hepatectomy for hepatocellular carcinoma.MethodsBetween 1990 and 2010, 31 patients aged 40 years or younger (younger patient group) among 811 consecutive patients with hepatocellular carcinoma who had undergone primary hepatectomy were analyzed with regard to patient factors, including liver function, tumor factors and operative factors. The clinicopathological characteristics of the younger patients were compared with those of patients over the age of 40 (older patient group). Then the prognostic factors of the younger patients were analyzed. Continuous variables were expressed as the means ± standard deviation and compared using the χ2 test for categorical variables. Overall survival and recurrence-free survival rates were determined by the Kaplan-Meier method and analyzed by the log-rank test. The Cox proportional hazards model was used for multivariate analysis.ResultsIn the younger patients, the rates of HBs-antigen-positivity, high alpha-fetoprotein, portal invasion, intrahepatic metastasis, large tumors, low indocyanin green retention rate at 15 minutes, and anatomical resection were significantly higher than the same measures in the older patients. The five-year overall survival rate of the young patients was 49.6%. The prognostic factors of survival were HCV-antibody-positivity and low albumin status. Prognostic factors of recurrence were multiple tumors and the presence of portal invasion.ConclusionsIn younger patients, survival appeared to be primarily affected by liver function, while recurrence was affected by tumor factors. Young patients with hepatocellular carcinoma should be aggressively treated with hepatectomy due to their good pre-surgical liver function.

Impact of age on the survival of patients with liver cancer: an analysis of 27,255 patients in the SEER database

“…This reduction in survival resulted from a more advanced tumor stage at diagnosis, despite the fact that they had better liver function. These results were confirmed by Shimada et al [ 25 ]. In addition, young patients tended to exhibit larger tumor sizes and poorer differentiation compared with older ones [ 26 ].…”

The prognosis of hepatocellular carcinoma after curative hepatectomy in young patients

“…Intrahepatic metastasis and multi-centric occurrence were determined according to the criteria of the Liver Cancer Study Group of Japan [ 12 ]. All patients were staged using the American Joint Committee on Cancer (AJCC) staging system [ 13 ] and Barcelona Clinic Liver Cancer (BCLC) staging classification [ 14 ]. The Institutional Review Board of Samsung Medical Center granted approval for this study.…”

“…Young patients have more frequent HBV infection, less frequent HCV infection and higher alpha-fetoprotein (AFP) levels [ 3 , 8 - 15 ]. They have relatively larger size and more advanced stage tumor than their elderly counterparts, while background liver function in young patients is relatively well preserved, as compared to older patients [ 3 , 8 , 10 - 14 ]. Clinical outcome may differ according to the balance between tumor's own biologic behavior and liver function thus explaining the inconclusive results in previous studies.…”

Association between age and overall survival of patients with hepatocellular carcinoma after hepatic resection

“…Thorough examination of the literature on age and post-resection outcomes [23][24][25][26][27][28][29][30][31][32][33][34] (Table III) indicates discrepancies in whether young age is associated with better or worse prognosis. Of 12 studies identified in our review, 10 reported similar OS for younger and older patients [23][24][25][26][27][28][29][30][31]33], one reported better OS for younger patients [32], and another reported poorer survival for younger patients [34].…”