Role of liver resection in treating intermediate and advanced stage adolescent and young adult hepatocellular carcinoma patients: A propensity-matching cohort study.

BACKGROUND: Hepatocellular carcinoma (HCC) in adolescent and younger adult (AYA) patients is usually diagnosed at an advanced stage such that curative treatments are often not possible. The aimed of this study was to compare the outcome of attempted curative treatment, liver resection (LR) versus transarterial chemoembolization (TACE), in AYA patients presenting with intermediate or advanced HCC defined by the Barcelona Clinic Liver Cancer (BCLC) stage B and C.

METHODS: All AYA patients diagnosed with BCLC stage B or C HCC undertaking LR (n = 276) and TACE (n = 136) were included in our study. The prognostic factors of the patients were analyzed and the propensity score-matched patients (120 pairs) were analyzed to adjust for any baseline differences.

RESULTS: The overall survival rate of the patients undertaking LR was higher than TACE for the both entire and the propensity matched population (p < 0.001). In the multivariate analysis, propensity scoring analyses suggested that HBsAg positivity, macrovascular invasion, tumor size and TACE treatment were the independent prognostic factors associated with a worse survival outcome.

CONCLUSION: The effect of LR was superior to that of TACE for patients with intermediate and advanced stage HCC. The survival outcome was associated with the tumor size, macrovascular invasion, and hepatitis history in AYA HCC patients.