Long-term oncologic outcomes of liver resection for hepatocellular carcinoma in adolescents and young adults: A multicenter study from a hepatitis B virus-endemic area - 16/09/21

Doi : 10.1016/j.amjsurg.2021.03.009

Yong-Kang Diao ^a,^b,^{^{1
These authors contributed equally to this work.}}, Jun-Wei Liu ^a,^b,^{^{1
These authors contributed equally to this work.}}, Han Wu ^c,^{^{1
These authors contributed equally to this work.}}, Ming-Da Wang ^c,^{^{1
These authors contributed equally to this work.}}, Xin-Ping Fan ^d,^{^{1
These authors contributed equally to this work.}}, Ting-Hao Chen ^e, Jian-Yu Wang ^e, Ya-Hao Zhou ^f, Wei-Min Gu ^g, Hong Wang ^h, Jie Li ⁱ, Ying-Jian Liang ^j, Zhi-Yu Chen ^k, Wan Yee Lau ^c,^l, Lei Liang ^a,^b, Chao Li ^a,^b, Cheng-Wu Zhang ^a, Feng Shen ^c, Dong-Sheng Huang ^a,^b,^⁎ , Tian Yang ^a,^b,^c,^⁎
^a Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
^b School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
^c Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
^d Department of General Surgery, Pingxiang Mining Group General Hospital, Jiangxi, China
^e Department of General Surgery, Ziyang First People’s Hospital, Sichuan, China
^f Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Yunnan, China
^g The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, China
^h Department of General Surgery, Liuyang People’s Hospital, Hunan, China
ⁱ Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Fuyang, Anhui, China
^j Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
^k Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
^l Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China

^∗Corresponding author. Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China.Department of Hepatobiliary Pancreatic and Minimal Invasive SurgeryZhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College)HangzhouZhejiangChina^∗∗Corresponding author. Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), and School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China.Department of Hepatobiliary Pancreatic and Minimal Invasive SurgeryZhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College)and School of Clinical MedicineHangzhou Medical CollegeHangzhouZhejiangChina

Abstract

Background

Hepatocellular carcinoma (HCC) is common among adolescents and young adults (AYAs) in areas with endemic hepatitis B virus infection. We sought to characterize clinical features and long-term outcomes among AYAs versus older adults (OAs) who underwent HCC resection.

Methods

From a Chinese multicenter database, patients were categorized as AYA (aged 13–39 years) versus OA (aged ≥40 years). Patient clinical features, perioperative outcomes, overall survival (OS) and time-to-recurrence (TTR) were compared. Multivariable Cox-regression analyses were performed to identify the impact of age on OS and TTR.

Results

Among 1952 patients, 354(22.2%) were AYAs. AYAs were less likely to have cirrhosis yet were likely to have advanced tumor pathological characteristics than OAs. Postoperative morbidity and mortality were comparable. Compared with OAs, AYAs had a comparable OS but a decreased TTR. Multivariable analyses identified that young age (<40 years) was independently associated with poorer TTR.

Conclusions

Compared with OAs, AYAs had a higher incidence of recurrence following liver resection among patients with HCC, suggesting that enhanced surveillance for postoperative recurrence may be required among AYAs.

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Highlights

•	Adolescents and young adults (AYA, 13–39 years) undergoing liver resection for hepatocellular carcinoma (HCC) were less often to have cirrhosis but more likely to have advanced tumor pathological characteristics than older adults (OA, ≥ 40 years).
•	Postoperative morbidity and mortality were comparable between AYAs and OAs with HCC.
•	Young age (<40 years) was independently associated with increased recurrence rate after curative HCC resection.

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Keywords : Hepatocellular carcinoma, Hepatectomy, Adolescents and young adults, Overall survival, Time-to-recurrence

Plan

Introduction

Materials and methods

Study population

Clinicopathologic characteristics and operative variables

Perioperative outcomes and follow-up

Study endpoints

Statistical analysis

Results

Comparisons of characteristics and operative variables

Comparisons of perioperative and long-term outcomes

Prognostic analyses of OS and TTR in the whole cohort

Prognostic analyses of OS and TTR among AYA patients

Discussion

Conclusion

Grant support

Role of the funding source

Author’s contribution

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Vol 222 - N° 4

P. 751-758 - octobre 2021 Retour au numéro

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Long-term oncologic outcomes of liver resection for hepatocellular carcinoma in adolescents and young adults: A multicenter study from a hepatitis B virus-endemic area - 16/09/21

Abstract

Background

Methods

Results

Conclusions

Highlights

Plan

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