Are More Young, Western Patients Also Developing Hepatocellular Carcinoma?

Area of Science:

• Oncology
• Hepatobiliary Surgery
• Cancer Epidemiology

Background:

• Rising incidence of early-onset cancers contrasts with unclear trends for early-onset hepatocellular carcinoma (eHCC).
• A clear definition for eHCC is lacking, necessitating an age cutoff determination.
• This study investigates eHCC incidence, clinical features, surgical results, and survival versus typical-onset HCC (tHCC).

Purpose of the Study:

• Establish an evidence-based age cutoff for defining early-onset hepatocellular carcinoma (eHCC).
• Analyze trends in eHCC incidence and compare clinical presentation, surgical outcomes, and survival with typical-onset HCC (tHCC).

Main Methods:

• Utilized the National Cancer Database (2010-2021) for hepatocellular carcinoma (HCC) patients.
• Defined eHCC (<50 years) and tHCC (≥50 years) statistically.
• Employed propensity score matching, multivariate hazard ratios, and Kaplan-Meier survival analysis.

Main Results:

• Identified 10,128 (4.88%) eHCC cases among 207,653 HCC patients; eHCC incidence decreased from 7.50% to 3.83% (2010-2021).
• eHCC demonstrated higher grade, synchronous metastasis, and nodal involvement but showed improved survival across all stages (p < 0.001).
• Post-matching, eHCC had better outcomes for stages I, II, and T1-T3 tumors, but not T4. Predictors of worse survival included tHCC, lack of insurance, and higher TNM stage.

Conclusions:

• A novel age cutoff for eHCC was defined, revealing a declining incidence despite general early-onset cancer trends.
• eHCC patients present with more advanced cancers but achieve superior surgical outcomes compared to tHCC.
• Younger patients with stage I, II, or T1-T3 eHCC experience favorable outcomes after resection.