Kim Jeong Hwan, Choi Moon Seok, Lee Hyuk, Kim Do Young, Lee Joon Hyeok, Koh Kwang Cheol, Yoo Byung Chul, Paik Seung Woon, Rhee Jong Chul
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2006 Mar;21(3):588-94. doi: 10.1111/j.1440-1746.2005.04127.x.
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. However, the clinical features of young HCC patients have not been fully studied. In the present study, we investigated the prevalence, clinical characteristics and prognosis of young HCC patients.
A retrospective analysis was performed for HCC patients in our center using Korean cancer registry data. Among 4234 patients enrolled, there were 38 patients younger than 30 years of age (0.9%). We compared clinical characteristics and survival data of these patients (group I) with those of sex-matched, randomly selected HCC patients aged 30-59 years (group II; n = 231) and 60 years or older (group III; n = 147).
Group I showed distinct features compared with groups II and III as follows: low frequency of smoking history, high positive rate of hepatitis B s antigen, no association with anti-hepatitis C virus antibody, high frequency of alpha-fetoprotein > or = 400 ng/mL, well-preserved liver function, larger tumor size, more advanced tumor-node-metastasis (TNM) stage and Cancer of the Liver Italian Program (CLIP) score and more frequent application of surgical resection and chemotherapy as initial treatment. The overall survival of group I was worse than that of group II, but similar to that of group III. Multivariate analysis showed that TNM stage and CLIP score, not age itself, were independent predictive factors for survival.
The results suggest that young HCC patients tend to have a poor prognosis owing to advanced tumor stage, despite well-preserved liver function and aggressive treatment. Further studies regarding the role of HCC screening in young people may be useful, especially in hepatitis B virus carriers from high endemic areas.
肝细胞癌（HCC）是全球最常见的癌症之一。然而，年轻HCC患者的临床特征尚未得到充分研究。在本研究中，我们调查了年轻HCC患者的患病率、临床特征及预后。
利用韩国癌症登记数据对本中心的HCC患者进行回顾性分析。在纳入的4234例患者中，有38例年龄小于30岁（0.9%）。我们将这些患者（I组）的临床特征和生存数据与年龄匹配、随机选择的30 - 59岁HCC患者（II组；n = 231）和60岁及以上患者（III组；n = 147）进行比较。
I组与II组和III组相比呈现出不同特征，如下：吸烟史频率低、乙肝表面抗原阳性率高、与抗丙型肝炎病毒抗体无关联、甲胎蛋白>或 = 400 ng/mL频率高、肝功能保存良好、肿瘤体积大、肿瘤-淋巴结-转移（TNM）分期和意大利肝癌项目（CLIP）评分更高级、作为初始治疗更频繁应用手术切除和化疗。I组的总生存率低于II组，但与III组相似。多变量分析表明，TNM分期和CLIP评分而非年龄本身是生存的独立预测因素。
结果表明，年轻HCC患者尽管肝功能保存良好且接受积极治疗，但由于肿瘤分期较晚，预后往往较差。关于HCC筛查在年轻人中的作用的进一步研究可能会有所帮助，尤其是在高流行地区的乙肝病毒携带者中。
