Clinical features of hepatocellular carcinoma with reference to ages in Korean patients

Cho, Yeong Jung; Lee, Soong Hwan; Kim, Byeong Hoon; Yang, Sung Kyu; Jo, Yong Hyun; Lee, Dong Hoo

Abstract

BACKGROUND
Hepatocellular carcinoma(HCC) has characteristic differences in both viral profiles and the most frequently occurring age in each country. It also has clinically distinct features between adult patients of the age under 65 and senile patients over 65 years. Herein we investigate differences in clinical features of the patients with HCC of the three different age groups : young patients (group 1) below 45 years of age; most frequently occurring age (45 - 65 year) (group 2); and elderly patients (group 3) above 65 years of age.
METHODS
The 371 HCC patients hospitalized and followed-up from 1986 to February 1997 have been analyzed. At the time of diagnosis there was no significant difference among the three groups in alcohol intake, cigarette smoking, sex, family history of liver disease, mean values of aminotransferases, Child-Pugh class, tumor location, TNM stage, tumor size, varix grade, metastasis, abdominal pain, ascites, encephalopathy, fever, or jaundice.
RESULTS
In the younger group HCC showed (1) a high incidence of HBsAg positivity (group 1, 95.3%; group 2, 78.6%; group 3, 25%; p<0.001) ; (2) a low positive rate of anti-HCV (group 1, 0%; group 2, 7.7%; group 3, 44.4; p<0.001); (3) a low incidence of NBNC(group 1, 4.9%; group 2, 14.1%; group 3, 30.4%; p<0.01); (4) a high incidence of diffuse type (group 1, 40.5%; group 2, 29.5%; group 3, 11.9%; p<0.05); (5) a higher levels of serum AFP (group 1, 4,180 ng/mL; group 2, 3,224 ng/mL; group 3, 2,025 ng/mL; between group 1 and group 3, p<0.05). But three different levels of AFP (<20 ng/mL, 20-400 ng/mL, >400 ng/mL) showed no differences among the three age groups (p=0.23766). (6) The overall survival rates did not differ statistically among the three groups (mean survival: group 1, 12 months; group 2, 18 months; group 3, 15 months; p=0.4635, log rank test).
CONCLUSION
These data support the younger patients with HCC are the most frequently associated with HBV contrarily to the elderly patients the more frequently associated with HCV or NBNC rather than HBV. This suggests, in turn, that the onset of HCC occurs one or two decades later in those with adult-acquired HCV than it does in lifelong HBV patients after neonatal vertical infection.