Prognosis Factors of Young Patients Undergoing Curative Resection for Hepatitis B Virus-Related Hepatocellular Carcinoma: A Multicenter Study
Received 9 May 2020
Accepted for publication 30 June 2020
Published 30 July 2020 Volume 2020:12 Pages 6597—6606
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Eileen O'Reilly
Jianxing Zeng,1– 3,* Kongying Lin,4,* Huocheng Liu,1,* Yao Huang,1– 3 Pengfei Guo,4 Yongyi Zeng,1– 3 Jinhua Zeng,1– 3 Jingfeng Liu1– 3
1Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China; 2The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People’s Republic of China; 3The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People’s Republic of China; 4Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jingfeng Liu Department of Hepatic Surgery
Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, People’s Republic of China
Tel/ Fax +86 591 8370 5927
Background: The prognosis of young and older patients with hepatocellular carcinoma (HCC) is controversial. We aim to compare the clinicopathological features and prognosis of young (age ≤ 40 years) versus older patients (aged > 40 years) with hepatitis B virus (HBV)-related HCC after curative resection.
Methods: A total of 4504 patients with HBV-related HCC who underwent curative resection were included in this study and divided into young group (n=699) and older group (n=3805). Subgroup analyses were conducted to compare. Independent risk factors were identified by Cox regression analysis.
Results: Young patients had better ALBI grade, lower rates of liver cirrhosis, higher rates of elevated serum AFP levels, larger tumor size, higher rates of microvascular invasion and macrovascular invasion, higher rates of Edmondson grade III–IV, lower rates of tumor capsular, more advanced AJCC TNM stages and more advanced BCLC stages than older patients (All p< 0.05). Meanwhile, young patients had a worse overall survival (OS) rate (p=0.0091) and a worse recurrence-free survival (RFS) rate (p=0.045) than older patients. Multivariate analysis revealed that AFP, resection margin, tumor size, tumor capsular, and macrovascular invasion were associated with OS. The independent risk factors associated with RFS were ALB, tumor size, microvascular invasion, and macrovascular invasion.
Conclusion: Young patients had better liver function, more aggressive tumor characteristics, and worse prognosis than older patients. A tumor size of ≥ 5 cm and macrovascular invasion were associated with poor OS and RFS in young patients. If tumors could be detected at the early stage by more frequent surveillance, long-term survival can be expected in the young patients.
Keywords: hepatocellular carcinoma, young, older, hepatectomy, prognosis
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