Impact of aging on the development of hepatocellular carcinoma in patients with posttransfusion chronic hepatitis C

Abstract

BACKGROUNDHepatitis C virus (HCV) infection is a heterogeneous disease, the natural history of which remains controversial. There is solid evidence that chronic HCV infection is responsible for the occurrence of hepatocellular carcinoma (HCC). The aim of the current cohort study was to determine the rate of the development of HCC from the time of primary HCV infection and to assess the risk factors for the development of HCC in chronic posttransfusion hepatitis C patients.METHODSFour hundred sixty‐nine patients with clinically compensated HCV, who had undergone a single blood transfusion comprised the current study cohort. Patients with other risk factors for chronic liver disease were excluded. All patients were referred to the liver center at the National Nagasaki Medical Center between December 1980 and December 1998 and were followed prospectively until the end of the analysis (June 2000).RESULTSFollow‐up data were obtained for 445 patients. The mean duration from HCV infection to the end of the observation was 28 years. Fifty‐two patients (11.1%) progressed to HCC. The mean duration from the time of blood transfusion to the diagnosis of HCC was 31 years. Multivariate Cox regression analyses revealed age, fibrosis, duration from HCV infection to study entry, and alcohol consumption to be the independent factors affecting the development of HCC. The risk of developing HCC in patients age ≥ 56 years was increased 7.8‐fold compared with that in patients age < 56 years. The mean age of patients at the time of HCC diagnosis was 65 years (range, 58–79 years).CONCLUSIONSAt the time of diagnosis, 92% of the 52 HCC patients were age > 60 years and 38 of the HCC patients (73%) were in their 60s. There was a significantly negative correlation between the duration from HCV infection to the development of HCC and the age of the patient at the time of infection (correlation coefficient = 0.702; P < 0.0001; Y = 61.1–0.82X), indicating that the age of patients, rather than the duration of HCV infection, is more significant for HCC development in patients with posttransfusion HCV. Moreover, these data may contribute to the design of an optimal follow‐up schedule for patients with posttransfusion HCV. Cancer 2002;95:331–9. © 2002 American Cancer Society.DOI 10.1002/cncr.10662

Late liver-related mortality from complications of transfusion-acquired hepatitis C

“…This trend is growing increasingly stronger, and the proportion of death by HCC among all causes of death in patients with cirrhosis and chronic HCV infection has reached 81%. 21 Hamada et al 22 reported that the age of the patient and duration of infection were independent risk factors affecting the development of HCC, and of them, age was the more significant. On average, approximately 30 years pass between the time of transfusion and the time of diagnosis of HCC.…”

“…On average, approximately 30 years pass between the time of transfusion and the time of diagnosis of HCC. 1,3,22 According to a nationwide survey in Japan, 23 the mean age at such diagnosis was 63.0 years for males and 66.5 years for females (75% of all patients were anti-HCV-positive). Ninety-two percent of HCC patients were 60 years or older at the time they were diagnosed with HCC.…”

“…Ninety-two percent of HCC patients were 60 years or older at the time they were diagnosed with HCC. 22 In the west of Scotland, agespecific incidence of HCC in men aged over 55 years increased dramatically between 1975 and 1985, particularly among those aged 75 to 84 years, but not in those younger than 55 years; the major etiology was considered to be HCV infection. 24 The patients in our study survived an average of 34 years after having received blood transfusion in early adulthood (at a mean age of 31 years); at the time of entry into the study they had become relatively elderly (average age, 65 years).…”

HCC develops even in the early stage of chronic liver disease in elderly patients with HCV infection

“…On the other hand, it has been reported that the majority of patients with posttransfusion chronic HCV infection develop HCC after the age of 60 years regardless of when they acquired the HCV infection (10). Moreover, with the increase in fibrosis of transplanted livers in HCV-infected patients, it has been reported that the age of the donor is closely correlated with the rate of progression of fibrosis of the transplanted liver rather than the age of the recipient (11).…”

“…Moreover, with the increase in fibrosis of transplanted livers in HCV-infected patients, it has been reported that the age of the donor is closely correlated with the rate of progression of fibrosis of the transplanted liver rather than the age of the recipient (11). Namely, the age of the patients who were infected with HCV is a more significant factor than the duration of the HCV infection in regards to the progression of HCV-persistent infection and fibrosis or carcinogenesis (10). Furthermore, in recent years the number of patients in which HCC does not occur before 60 years of age but thereafter develops in patients in their 70s or 80s has been increasing (12)(13)(14)(15)(16).…”