Clinical Implications and Novel Insights into Adolescent Primary Liver Cancer: A Nightmare for Adolescents?
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OBJECTIVE: This study retrospectively analyzed clinical data from adolescent primary liver cancer (PLC) cases over the past decade, summarizing clinical characteristics, diagnostic approaches, and prognostic outcomes to provide guidance for prevention, early diagnosis, and timely treatment of adolescent PLC. METHODS: Clinical data of 497 cases of adolescent PLC patients were collected from January 1, 2014, to December 31, 2024. The baseline demographic data, general condition, imaging, laboratory findings, and pathological features of these patients were described, and the diagnostic and therapeutic processes were analyzed, univariate and multivariate Cox regression analyses were conducted to identify significant prognostic factors. RESULTS: The age of onset for patients was 13.75 (10.25-19.00) years, with 311 males (62.58%) and 186 females (37.42%), yielding a male-to-female ratio of 1.67:1. Elevated ALT and GGT levels were observed in most patients, while all patients exhibited elevated ChE. Among all patients included in this study, 320 cases (64.39%) were infected with HBV, 469 cases (94.36%) were diagnosed with hepatocellular carcinoma (HCC), 14 cases (2.82%) with intrahepatic cholangiocarcinoma, and 14 cases (2.82%) with mixed hepatocellular-intrahepatic cholangiocarcinoma. The follow-up results showed the 1-year, 2-year, and 3-year survival rates in adolescent PLC patients were 45.27%, 20.32%, and 8.45%, respectively. The univariate Cox regression analysis revealed that adolescent PLC patients who accompanied with portal vein tumor thrombus, ascites, advanced CNLC stage, abnormalities in AFP, ALT, AST, AST/ALT ratio, GGT, ALP and TBIL, high ECOG score and non-surgical treatment had shorter OS (P < 0.05). Multivariate Cox regression analysis showed that portal vein tumor thrombus, advanced CNLC stage, abnormalities in AFP, GGT, and non-surgical treatment were independent prognostic factors influencing the OS of adolescent PLC patients (P < 0.05). CONCLUSION: Clinical manifestations and symptoms of adolescent PLC patients lack specificity, and portal vein tumor thrombus, advanced CNLC stage, abnormalities in AFP, GGT, and non-surgical treatment were independent prognostic factors influencing OS in adolescent PLC.