title: Different presentation of hepatitis B-related hepatocellular carcinoma in a cohort of 1863 young and old patients - implications for screening.
abstract: OBJECTIVE
  To compare the clinico-pathological features of hepatitis B virus-related hepatocellular carcinoma in young and old patients.
  
  
  METHODS
  The clinico-pathological characteristics of hepatitis B virus-related hepatocellular carcinoma were compared in 1863 consecutive patients (121 patients, </=40 years; 1742 patients, > 40 years) seen at a single institution over the last 13 years.
  
  
  RESULTS
  Young patients presented more often with pain (P < 0.0001), hepatomegaly (P = 0.01) and ruptured hepatocellular carcinoma (P = 0.02), whereas old patients presented with ankle oedema (P = 0.001), ascites (P = 0.002) and by routine screening (P = 0.035). Liver function, Child-Pugh grading and indocyanine green test were better preserved in young patients. They also had a higher alpha-foetoprotein concentration (P = 0.001), larger tumour size (P = 0.001) and more frequent metastasis (P = 0.008), but a similar surgical resection rate (33.6% vs. 28%), to old patients. There was no difference between the two groups in the overall post-resection survival rate, but there was a shorter survival in young patients with unresectable disease (3.6 months vs. 4.6 months, P = 0.004). Young patients with hepatocellular carcinoma often show a later presentation, but a higher resectability rate and similar survival rates, than old patients. The screening programme should include young hepatitis B virus carriers, even in the absence of cirrhosis.
authors.affiliation: Centre for the Study of Liver Disease, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong. lamcm@hkucc.hku.hk
authors.forename: C-M
authors.initials: CM
authors.lastname: Lam
authors.forename: A O O
authors.initials: AO
authors.lastname: Chan
authors.forename: P
authors.initials: P
authors.lastname: Ho
authors.forename: I O-L
authors.initials: IO
authors.lastname: Ng
authors.forename: C M
authors.initials: CM
authors.lastname: Lo
authors.forename: C L
authors.initials: CL
authors.lastname: Liu
authors.forename: R T P
authors.initials: RT
authors.lastname: Poon
authors.forename: S T
authors.initials: ST
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000821:virology*; D015331:Cohort Studies; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000821:virology*; D008875:Middle Aged; D009367:Neoplasm Staging; D016019:Survival Analysis