Early-Onset HCC Associated With Better Prognosis Than Late-Onset Disease

About 25,000 new hepatocellular carcinoma (HCC) cases are diagnosed annually, and the disease accounts for approximately 85% to 90% of all primary liver cancers.

Little is known about the differences in distant metastasis (DM) and prognosis between early- and late-onset HCC. To help fill this knowledge gap, Hanlong Zhu, MD, and colleagues conducted a comprehensive analysis to determine the association between HCC disease stage and prognosis.

Data from patients with HCC were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database and the researchers’ own center at Jinling Hospital in Nanjing, China. Demographics, tumor characteristics, and survival were compared between the 2 groups. Researchers analyzed risk factors and prognosis of DM using logistic and Cox analyses, while survival differences were assessed using Kaplan-Meier curves and log-rank tests.

A total of 19,817 patients with HCC from the SEER database were enrolled, along with 129 patients from Jinling Hospital. Of the patients from the SEER database, 3376 were identified in the matched cohort (1688 early-onset patients and 1688 late-onset patients).

Compared with late-onset HCC, early-onset HCC was found to occur more often in female patients (25.2% vs 22.9%; P=.030). Early-onset disease was also associated with larger tumors (>10 cm, 24.1% vs 14.6%; P=.000), poorly differentiated/undifferentiated cancers (17.0% vs 14.0%; P =.003), advanced clinical stage (T3+T4, 33.7% vs 28.5%; N1, 9.2% vs 6.7%; P=.000), and development of DM (13.0% vs 9.5%; P=.000). It also served as an independent risk factor for DM.

Despite its association with unfavorable disease characteristics such as frequent development of DM, early-onset HCC was also an independent favorable predictor of survival and showed a superior prognosis compared with late-onset HCC. However, previous survival analyses offer paradoxical results. Further studies are warranted to verify the survival rates and outcomes of early- versus late-onset HCC.