Cheah Daniel S, Tsai Kathryn, Kawano Fumihiro, Kemprecos Helen J, Salirrosas Oscar, Tigranyan Annie, Cohen Mark S, Polites Gregory, Kutlu Onur C, Mise Yoshihiro, Saiura Akio, Conrad Claudius
Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA.
Carle Foundation Hospital, Urbana, IL, USA.
Ann Surg Oncol. 2025 Jun;32(6):3924-3932. doi: 10.1245/s10434-025-17042-0. Epub 2025 Mar 10.
While the incidence of early-onset cancers is rising, it is unclear whether this is the case for early-onset hepatocellular carcinoma (eHCC). Even the definition of eHCC remains unclear. This study was designed to identify an age cutoff for eHCC and to explore trends in its incidence, clinical presentation, surgical outcomes, and long-term survival compared to typical-onset HCC (tHCC).
The National Cancer Database was queried for HCC patients (2010-2021). Both eHCC (< 50 years) and tHCC (≥ 50 years) were statistically defined. Propensity score matching adjustment, multivariate hazard ratios, and stage-dependent Kaplan-Meier survival analysis were calculated.
Among 207,653 patients, 10,128 (4.88%) had eHCC, with decreasing incidence from 2010 to 2021 (7.50% to 3.83%). eHCC had higher grade, synchronous metastasis, and nodal involvement. Independent predictors of worse 5-year survival included tHCC, uninsured, and higher TNM staging. Despite worse clinical characteristics, eHCC had improved survival across all stages (p < 0.001). After matching, eHCC had improved outcomes for stage I, II (p < 0.001, p = 0.004), and T1-T3 tumors (p < 0.001, p = 0.002, p = 0.045), but not T4. Minority status, lack of insurance, lower income, and greater distance to the hospital are independent predictors of eHCC.
After defining a novel, evidence-based age cutoff for eHCC, data indicate that while cancer incidence among younger patients is generally rising, the incidence of eHCC is declining. Although eHCC are more advanced cancers, they have improved outcomes compared to tHCC when undergoing surgery. In this context, especially young patients with stage I, II, or tumor ≤ T3 have favorable outcomes following resection.
虽然早发型癌症的发病率在上升，但早发型肝细胞癌（eHCC）是否如此尚不清楚。甚至eHCC的定义也不明确。本研究旨在确定eHCC的年龄界限，并探讨其与典型发病肝细胞癌（tHCC）相比在发病率、临床表现、手术结果和长期生存方面的趋势。
查询国家癌症数据库中的HCC患者（2010 - 2021年）。从统计学上定义eHCC（<50岁）和tHCC（≥50岁）。计算倾向评分匹配调整、多变量风险比和分期依赖性Kaplan-Meier生存分析。
在207,653例患者中，10,128例（4.88%）患有eHCC，其发病率从2010年到2021年呈下降趋势（7.50%至3.83%）。eHCC具有更高的分级、同步转移和淋巴结受累。5年生存率较差的独立预测因素包括tHCC、未参保和更高的TNM分期。尽管临床特征较差，但eHCC在所有分期的生存率均有所提高（p < 0.001）。匹配后，eHCC在I期、II期（p < 0.001，p = 0.004）以及T1 - T3肿瘤（p < 0.001，p = 0.002，p = 0.045）的治疗结果有所改善，但T4期无改善。少数族裔身份、未参保、低收入以及距离医院较远是eHCC的独立预测因素。
在为eHCC定义了一个新的、基于证据的年龄界限后，数据表明虽然年轻患者的癌症发病率总体上在上升，但eHCC的发病率在下降。尽管eHCC是更晚期的癌症，但与tHCC相比，它们在接受手术时的治疗结果有所改善。在这种情况下，尤其是I期、II期或肿瘤≤T3的年轻患者在切除术后有良好的治疗结果。
