Pathologic features and patient survival in hepatocellular carcinoma in relation to age

For hepatocellular carcinoma, the peak age of patients is at the sixth decade. However, the influence of age on the tumor biologic behavior and long-term patient survival is controversial. We retrospectively studied 278 patients whose hepatocellular carcinomas were surgically resected to analyze the pathologic and clinical features of the tumors and patient survival in relation to age. The patients were divided into two groups, younger than 50 years of age and older than 50 years. Ninety-seven patients were 50 years of age or under, and 181 were older than 50 years. The younger patients had: (1) more frequent hepatitis B surface antigen positivity (P = 0.022), (2) less cirrhosis (P = 0.050), (3) less tumor encapsulation, (4) a more advanced tumor stage in terms of more venous permeation (P = 0.012), more liver invasion (P = 0.010) and larger tumor (P = 0.002), and (5) a more frequently raised serum alpha-fetoprotein level (P = 0.035). In spite of the more advanced stage of the tumors, both the actuarial and disease-free survival rates did not differ significantly from those of the older group. The operative mortality rates also were similar in both groups. To conclude, there were distinct differences in the clinical and pathologic features of the tumors of patients < 50 years and those older. Although the tumors were more advanced in the younger group, the less frequently associated cirrhosis in this group might have partly compensated to result in survival rates similar to those of the older group. Because of the comparable survival rates, the treatment policy in the older group should not differ greatly from that in the younger group.