title: Clinical and pathologic factors associated with survival in young adult patients with fibrolamellar hepatocarcinoma.
abstract: BACKGROUND
  Fibrolamellar Carcinoma (FLC), a subtype of hepatocellular carcinoma (HCC), is a rare primary hepatic malignancy. Several aspects of the clinic features and epidemiology of FLC remain unclear because most of the literature on FLC consists of case reports and small cases series with limited information on factors that affect survival.
  
  
  METHODS
  We did a retrospective analysis of the clinical and histological characteristics of FLC. We also determined the rate of cellular proliferation in biopsies of these tumors. We assessed whether these variables were associated with survival.
  
  
  RESULTS
  We found 15 patients with FLC out of 174 patients with HCC (8.6%). Between patients with these neoplasms, we found statistically significant survival, age at onset, level of alpha fetoprotein, and an earlier stage of the disease. The 1, 3 and 5 year survival in patients with FLC was of 66, 40 and 26% respectively. The factors associated with a higher survival in patients with FLC were age more than 23 years, feasibility of surgical resection, free surgical borders, absence of thrombosis or invasion to hepatic vessels and the absence of alterations in liver enzymes. The size of the tumor, gender, cellular proliferation and atypia did not affect the prognosis.
  
  
  CONCLUSIONS
  We concluded that FLC patients diagnosed before 23 years of age have worse prognosis than those diagnosed after age 23. Other factors associated with worse prognosis in this study are: lack of surgical treatment, presence of positive surgical margins, vascular invasion, and altered hepatic enzymes.
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. laura_moreno@hotmail.com
authors.forename: Laura E
authors.initials: LE
authors.lastname: Moreno-Luna
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
authors.forename: Jorge
authors.initials: J
authors.lastname: García-Leiva
authors.forename: Braulio
authors.initials: B
authors.lastname: Martínez
authors.forename: Aldo
authors.initials: A
authors.lastname: Torre
authors.forename: Misael
authors.initials: M
authors.lastname: Uribe
authors.forename: Eucario
authors.initials: E
authors.lastname: León-Rodríguez
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D049109:Cell Proliferation; D018572:Disease-Free Survival; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome