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Younger patients more likely to experience HCC recurrence after LT

Researchers in China found that aggressive tumors were more likely to be found in younger patients who underwent liver transplantation for hepatocellular carcinoma, which led to an increased risk for recurrence vs. older patients.

“Age is a complex prognostic factor in [hepatocellular carcinoma] and may play a paradoxical role in the prognosis of [hepatocellular carcinoma] patients,” the researchers wrote.

In a single-center study performed at Affiliated First People’s Hospital, Shanghai Jiao Tong University, in People’s Republic of China, data of 290 patients with hepatocellular carcinoma who underwent liver transplantation (LT) between January 2001 and December 2011 were analyzed. Patient characteristics and survival curves were compared between patients (259 men, 31 women) aged less than 50 years (n = 135) and patients aged 50 years and older (n = 155). Cox multivariate regression analysis was then used to determine any risk factors for survival in both groups of patients.

“Younger age was associated with higher alpha-fetoprotein (P = .014), larger tumor size (P = .038), poorer differentiation (P = .025), portal lymph node metastasis (P = .001) and high recurrence rate (P = .038),” the researchers wrote.

Older patients had a longer recurrence-free survival rate (P = .02) and overall survival rate (P = .014) compared with younger patients. Yet, there were no significant differences between the younger and older patients who met the Milan criteria (P > .05), according to the research.

According to Kaplan-Meier survival curves, the recurrence-free survival rate was 59.7% at 1 year, 44.5% at 3 years and 37.3% at 5 years in the younger group of patients compared with 67.9%, 55.3% and 53.8% in the older patient group.

The overall survival rate was 68.4% at 1 year, 45.5% at 3 years and 38.9% at 5 years in the younger group compared with 76.1%, 59.7%, and 53.9% in the older group.

“Aged patients had better prognosis in this study,” the researchers wrote.

“Alpha-fetoprotein levels greater than 400 ng/mL, microvascular invasion and a tumor greater than 5 cm were independent risk factors for prognosis in both groups,” they wrote.

“Our single center experience suggests that younger patients should be assessed more rigorously before LT, while aged patients should be actively considered for LT after appropriate selection,” the researchers concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.