Clinicopathologic features and prognosis of young patients with hepatocellular carcinoma in a large German cohort.
OBJECTIVE
Hepatocellular carcinoma in non-hepatitis B virus endemic areas is rare in patients younger than 40 years of age. The aim of this study was to characterize young patients in a large German cohort in comparison with older patients with regard to underlying liver disease, clinical management, and survival.


METHODS
We analyzed the clinical data and medical records of 1108 consecutive patients with confirmed hepatocellular carcinoma. Twenty-five patients (2%) were younger than 40 years of age. We compared this subgroup with patients older than 40 years of age.


RESULTS
Underlying chronic liver disease was less common in young patients and detectable in only 56% of patients. Fibrolamellar carcinoma was more frequent in young versus old patients (20% vs. 0.7%; P<0.001). There was a trend toward more potentially curative treatment options in young patients, and overall survival was longer in the young group compared with older patients (56.0 vs. 15.2 mo; P=0.048).


CONCLUSIONS
This western cohort of young patients is distinctly different from described Asian cohorts, especially with regard to a lower rate of underlying liver disease and particularly hepatitis B virus. Young patients had a better overall survival than older patients.
Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. ina.niederle@unimedizin-mainz.de
Ina M
IM
Niederle
Marcus-Alexander
MA
Wörns
Sandra
S
Koch
Marc
M
Nguyen-Tat
Christoph
C
Düber
Gerd
G
Otto
Marcus
M
Schuchmann
Peter R
PR
Galle
Arndt
A
Weinmann
D000328:Adult; D000368:Aged; D000375:Aging; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate; D055815:Young Adult