Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2020; 12(12): 1394-1406
Published online Dec 15, 2020. doi: 10.4251/wjgo.v12.i12.1394
Comparison of survival between adolescent and young adult vs older patients with hepatocellular carcinoma
Jie Ren, Ying-Mu Tong, Rui-Xia Cui, Zi Wang, Qing-Lin Li, Wei Liu, Kai Qu, Jing-Yao Zhang, Chang Liu, Yong Wan
Jie Ren, Ying-Mu Tong, Rui-Xia Cui, Zi Wang, Qing-Lin Li, Wei Liu, Kai Qu, Jing-Yao Zhang, Chang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jing-Yao Zhang, Chang Liu, Department of SICU, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Yong Wan, Department of Geriatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Ren J, Tong YM, and Cui RX contributed equally to this work; Ren J participated in the research design, data analysis, and writing of the paper; Tong YM and Cui RX participated in the data analysis; Wang Z, Liu W, and Li QL participated in revising of the paper; Qu K participated in research design and revising of the paper; Zhang JY, Liu C, and Wan Y provided substantial advice in designing the study, assisting in the division of labor, and writing and revising the paper; all authors have read and approved the final manuscript.
Institutional review board statement: The IRB has reviewed this information and found that this protocol does not fall under the purview of the IRB as it does not meet the definition of human subject research.
Informed consent statement: As the data used was accessed via a public national database with deidentified patients, there was no need for informed consent.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: Data from this manuscript will be available upon request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Wan, MD, Chief Physician, Department of Geriatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an 710061, Shaanxi Province, China. rareyong@qq.com
Received: August 31, 2020
Peer-review started: August 31, 2020
First decision: September 12, 2020
Revised: September 20, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 15, 2020
Processing time: 100 Days and 20.9 Hours
Abstract
BACKGROUND

Due to the special clinical features and biologic characteristics of adolescent and young adult (AYA) cancers, AYA cancers are different from cancers in children and elderly individuals. However, there are few reports on AYA hepatocellular carcinoma (HCC).

AIM

To investigate the overall survival (OS) of AYA (15-39 years) and elderly (40-74 years) patients with HCC.

METHODS

The data of all the HCC cases were extracted from the Surveillance, Epidemiology, and End Results database from 2004 to 2015 and were then divided into two groups based on age: AYA group (15-39 years) and older group (40-74 years). Kaplan-Meier curves and log-rank tests were used to compare the OS of the two groups. Propensity score matching (PSM) was employed to analyze the OS difference between the two groups. The Cox proportional hazards regression model was used to perform multivariate analysis to explore the risk factors for OS of HCC patients.

RESULTS

Compared to elderly cancer patients, AYA patients with HCC had a worse Surveillance, Epidemiology, and End Results stage, including the distant stage (22.1% vs 15.4%, P < 0.001), and a more advanced American Joint Committee on Cancer (AJCC) stage, including AJCC III and IV (49.2% vs 38.3%, P < 0.001), and were more likely to receive surgery (64.5% vs 47.5%, P < 0.001). Before PSM, the AYA group had a longer survival in months (median: 20.00, interquartile range [IQR]: 5.00-62.50) than the older group (median: 15.00, IQR: 4.00-40.00) (P < 0.001). After PSM, the AYA group still had a longer survival in months (median: 21.00, IQR: 5.00-64.50) than the older group (median: 18.00, IQR: 6.00-53.00) (P < 0.001). The Cox proportional hazards regression model showed that advanced age (hazard ratio [HR] = 1.405, 95%CI: 1.218-1.621, P < 0.001) was a risk factor for OS of HCC patients. In the subgroup analysis, the Cox proportional hazards regression model showed that in AJCC I/II HCC patients, advanced age (HR = 1.749, 95%CI: 1.352-2.263, P < 0.001) was a risk factor for OS, while it was not a risk factor in AJCC III/IV HCC patients (HR = 1.186, 95%CI: 0.997-1.410, P = 0.054) before PSM. After PSM, advanced age (HR = 1.891, 95%CI: 1.356-2.637, P < 0.001) was still a risk factor for OS in AJCC I/II HCC patients, but was not a risk factor for OS in AJCC III/IV HCC patients (HR = 1.192, 95%CI: 0.934-1.521, P = 0.157) after PSM.

CONCLUSION

AYA patients with HCC have different clinical characteristics from older adults. In different AJCC stages, the two groups of patients have different OS: In AJCC I/II HCC patients, advanced age is a risk factor for OS, but it is not a risk factor for OS in the AJCC III/IV HCC patient group.

Keywords: Adolescent and young adults; Older adults; Hepatocellular carcinoma; Overall survival; Propensity score matching; Risk factor

Core Tip: Adolescent and young adult (AYA) population refer to people aged 15-39 years old in the United States, and AYA has become a special age phase in oncology research in recent years. We aimed to investigate overall survival (OS) of AYA and older hepatocellular carcinoma patients. Our study confirmed that in different American Joint Committee on Cancer (AJCC) stages, the two groups of patients had different OS: In the AJCC I/II group, advanced age was a risk factor for OS, but it was not a risk factor for OS in the AJCC III/IV group.