title: Clinical prognostic variables in young patients (under 40 years) with hepatitis B virus-associated hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of hepatocelluar carcinoma (HCC) screening in chronic hepatitis B patients who did not meet the current screening recommendations.
  
  
  METHODS
  Patients who were admitted to Bellevue Hospital Center with HCC were assessed for risk factors, cirrhosis and tumor-specific factors. Eligibility for liver transplantation or resection with favorable outcome was determined by applying Milan criteria.
  
  
  RESULTS
  In all 93 patients were diagnosed with hepatitis B virus (HBV)-associated HCC, 18 of whom were under 40 years. Cirrhosis was infrequently associated with HCC in this group, with most cancers occurring in non-cirrhotic patients (12/18, 66.7%). No patient developed HCC outside the American Association for the Study of Liver Diseases (AASLD) cancer screening recommendations (young age, non-cirrhotic) were eligible for liver transplantation or resection with favorable outcomes (within Milan criteria). However, HCC patients who were diagnosed within AASLD screening recommendations did meet Milan criteria in 17.3% (14/81) patients.
  
  
  CONCLUSIONS
  Current guidelines for HCC screening in patients with HBV may lead to a delay in diagnosis in non-cirrhotic patients under 40 years. Consideration should be given to modifying current recommendations to advocate entering HBV patients into a cancer-screening program at young age.
authors.affiliation: Division of Surgical Oncology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Luan
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Villanueva
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Herman T
authors.initials: HT
authors.lastname: Yee
authors.forename: Fotini
authors.initials: F
authors.lastname: Manizate
authors.forename: Spiros P
authors.initials: SP
authors.lastname: Hiotis
mesh_terms: D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D003362:Cost-Benefit Analysis; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000592:standards; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult