TY - JOUR
T1 - Clinical and pathologic features of hepatocellular carcinoma in young and older Italian patients
AU - Trevisani, Franco
AU - D'Intino, Paola E.
AU - Grazi, Gian L.
AU - Caraceni, Paolo
AU - Gasbarrini, Antonio
AU - Colantoni, Alessandra
AU - Stefanini, Giuseppe F.
AU - Mazziotti, Alighieri
AU - Gozzetti, Giuseppe
AU - Gasbarrini, Giovanni
AU - Bernardi, Mauro
PY - 1996/6/1
Y1 - 1996/6/1
N2 - BACKGROUND. It is not known whether putative etiologic factors and clinical and pathological features of hepatocellular carcinoma (HCC) differ between young adult and older white patients. METHODS. We examined the characteristics of 498 consecutive patients with HCC age <50 years (Group 1: 54 patients) and age ≥ 50 (Group 2: 444 patients), an age beyond which the tumor occurrence rate briskly increases. RESULTS. Demographic characteristics, alcohol and coffee intake, and cigarette smoking did not differ between the two groups. Group 1 had a greater prevalence of the hepatitis B surface antigen (HBsAg) carriers (P = 0.006), while the prevalence of either past hepatitis B virus infection (P = 0.008) or antivirus C antibodies (P = 0.016) was higher in Group 2. The lack of both hepatitis B and C virus serologic markers was more common in Group 1 (P = 0.018). In these patients, HCC was less frequently superimposed on cirrhosis (P = 0.002) and was more advanced at the time of diagnosis. In fact, despite a better histologic differentiation grade (P = 0.019), monofocal (solitary and massive) tumors were larger (P = 0.012), small lesions (≤5 cm) less frequent (P = 0.028), and either diffuse (P <0.001) or massive (P = 0.011) types more common. An elevation of serum α-fetoprotein was less frequent in group 1 (P = 0.016), but this difference disappeared when the 'diagnostic' cut-off of 400 ng/mL was considered. Albeit the prevalence of presenting symptoms did not significantly differ between the two groups, the clinical stage was more advanced in young patients (P = 0.004). The 9-year cumulative rate of survival was similar in the 2 groups. CONCLUSIONS. An early exposure to the virus and/or an accelerated hepatocarcinogenesis in HBsAg carriers can be inferred. Moreover, in the period of life at low risk for hepatoma: (1) the impact of nonalcoholic chemical carcinogenesis seems to be greater; (2) the tumor occurrence is less dependent on cirrhosis development; (3) although histologically better differentiated, the neoplasm is more advanced at the time of diagnosis; and (4) the long term survival is similar to that of the patients age 50 years or older.
AB - BACKGROUND. It is not known whether putative etiologic factors and clinical and pathological features of hepatocellular carcinoma (HCC) differ between young adult and older white patients. METHODS. We examined the characteristics of 498 consecutive patients with HCC age <50 years (Group 1: 54 patients) and age ≥ 50 (Group 2: 444 patients), an age beyond which the tumor occurrence rate briskly increases. RESULTS. Demographic characteristics, alcohol and coffee intake, and cigarette smoking did not differ between the two groups. Group 1 had a greater prevalence of the hepatitis B surface antigen (HBsAg) carriers (P = 0.006), while the prevalence of either past hepatitis B virus infection (P = 0.008) or antivirus C antibodies (P = 0.016) was higher in Group 2. The lack of both hepatitis B and C virus serologic markers was more common in Group 1 (P = 0.018). In these patients, HCC was less frequently superimposed on cirrhosis (P = 0.002) and was more advanced at the time of diagnosis. In fact, despite a better histologic differentiation grade (P = 0.019), monofocal (solitary and massive) tumors were larger (P = 0.012), small lesions (≤5 cm) less frequent (P = 0.028), and either diffuse (P <0.001) or massive (P = 0.011) types more common. An elevation of serum α-fetoprotein was less frequent in group 1 (P = 0.016), but this difference disappeared when the 'diagnostic' cut-off of 400 ng/mL was considered. Albeit the prevalence of presenting symptoms did not significantly differ between the two groups, the clinical stage was more advanced in young patients (P = 0.004). The 9-year cumulative rate of survival was similar in the 2 groups. CONCLUSIONS. An early exposure to the virus and/or an accelerated hepatocarcinogenesis in HBsAg carriers can be inferred. Moreover, in the period of life at low risk for hepatoma: (1) the impact of nonalcoholic chemical carcinogenesis seems to be greater; (2) the tumor occurrence is less dependent on cirrhosis development; (3) although histologically better differentiated, the neoplasm is more advanced at the time of diagnosis; and (4) the long term survival is similar to that of the patients age 50 years or older.
KW - α-fetoprotein
KW - age
KW - clinical features
KW - etiology
KW - hepatocellular carcinoma
KW - pathology
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U2 - 10.1002/(SICI)1097-0142(19960601)77:11<2223::AID-CNCR7>3.0.CO;2-Q
DO - 10.1002/(SICI)1097-0142(19960601)77:11<2223::AID-CNCR7>3.0.CO;2-Q
M3 - Article
C2 - 8635088
AN - SCOPUS:9344254953
VL - 77
SP - 2223
EP - 2232
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 11
ER -