Abstract
Age at diagnosis is a reported prognostic factor in a variety of solid cancers. In hepatocellular carcinomas (HCCs), several previous studies focused on patient age, but demonstrated inconclusive results on prognosis of young patients. Clinical outcome may differ according to the balance between tumor's own biologic behavior and underlying liver function thus explaining the inconclusive results in previous studies. In this study, we enrolled 282 patients who underwent curative hepatectomy for primary HCCs and had Child Pugh Class A, representing good liver function. Clinicopathologic features were compared between patients aged ≤40 years (young age group) and those aged >40 years (old age group). Thirty-five patients (12.4%) were classified as the young age group and showed larger tumor size (>5cm), higher Edmondson grade, more frequent intrahepatic metastasis and higher alpha-fetoprotein level (>200ng/mL) than old age group. Young age group showed shorter disease specific survival than the old age group. Symptomatic presentation without surveillance was more frequent in the young age group than old age group (45.7% vs. 23.9%). In gene expression profiling analysis, 69 differentially expressed genes between young and old age groups were generated and these genes were mostly associated with cell cycle or cell division. Mitotic rate was significantly higher in HCCs of young patients than those of old patients. In conclusion, HCCs in young patients have distinct clinicopathologic features. Poor prognosis in the young age group could be explained by late detection as well as their own aggressive tumor biology.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common solid cancers and the second leading cause of cancer-related deaths globally, with only 7% of 5 year survival rate [1]
We evaluated the prognosis of young patients among the 282 HCC patients with long term follow- up
The prognosis of young HCC patients were inconclusive in previous studies [3, 8,9,10,11,12,13,14,15]
Summary
Hepatocellular carcinoma (HCC) is one of the most common solid cancers and the second leading cause of cancer-related deaths globally, with only 7% of 5 year survival rate [1]. HCC usually occurs in middle aged and elderly patients, the peak age of incidence is different in various countries [3]. The age at diagnosis in HCC patients is lower in hepatitis B- endemic country, such as Korea, than in hepatitis C- endemic areas, such as Western countries [3]. Age at diagnosis is a reported prognostic factor in a variety of solid cancers. Young patients with gastric or breast cancer have more aggressive disease and poorer prognosis than older ones [4, 5]. Young patients have a better clinical outcome than their elderly counterpart in thyroid papillary carcinoma and colorectal cancer [6, 7]. Some authors reported better survival rates in young HCC patients, as compared to older patients [3, www.impactjournals.com/oncotarget
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