Journal of Liver Cancer

Review Articles

Management of hepatocellular carcinoma in elderly and adolescent/young adult populations: Han Ah Lee; J Liver Cancer. 2025;25(1):52-66. Published online March 20, 2025; DOI: https://doi.org/10.17998/jlc.2025.02.28

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Abstract PDF: Hepatocellular carcinoma (HCC) presents unique challenges in both the elderly and adolescent/young adult (AYA) populations, requiring distinct management approaches. Recent epidemiological data show an increasing incidence of HCC in both age groups, with elderly cases rising significantly and AYA cases showing trends in specific regions. The clinical characteristics and treatment considerations vary substantially among these populations. Elderly patients with HCC typically present with hepatitis C virus infection, metabolic dysfunction-associated steatotic liver disease, well-differentiated tumors, and multiple comorbidities. In contrast, AYA patients with HCC often present with more aggressive tumor characteristics and predominantly with hepatitis B virus-related diseases. Treatment decisions for elderly patients with HCC require careful consideration of physiological reserves, comprehensive geriatric assessments, and potential complications. Recent studies have demonstrated that elderly patients can achieve outcomes comparable to younger patients across various treatment modalities when properly selected. While surgical outcomes are comparable to those of younger patients with proper selection, less-invasive options such as radiofrequency ablation or transarterial therapies may be more appropriate for some elderly patients. The treatment approach for AYA HCC emphasizes curative intent while considering long-term effects. AYA patients require specialized attention to their psychosocial needs, fertility preservation, and long-term health maintenance. Although data on AYA patients remain limited, they are known to have relatively favorable prognoses despite exhibiting more aggressive tumor characteristics. Management of HCC in both the elderly and AYA populations requires individualized approaches that consider age-specific factors. Both groups benefit from multidisciplinary team involvement and careful consideration of quality of life.

Is Hepatocellular Carinoma in Young Patients More Aggressive than Old Patients?: Jung Min Lee, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):24-28. Published online June 30, 2009

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Abstract PDF: In Korea, hepatocellular carcinoma (HCC) is a fourth leading malignancy with poor prognosis of 5 year survival reaching just 18.9%. The peak incidence is 6th decade and the incidence drops with decreasing age. However, young patients with HCC are not uncommonly encountered in clinical practice, and notably, even though managements with all available modalities are undertaken in these patients, the prognosis does not seem to be better. As such, many physicians feel that the behavior of HCC in young patients takes a more aggressive course than that in old patients. From this perspective, we performed a systemic review of previous literatures focusing on the question whether or not HCC in young patients is more aggressive; it was found that young patients with HCC had presentation of more advanced stage, more preserved liver function, but poor or equivocal survival rate. In the multivariate analysis, however, the poor outcome resulted not from young age, but from advanced stage, which was supported by similar or better outcome when the prognosis was compared with the same stage between young and old patients. Consequently, it could be inferred that an earlier detection of the tumor through earlier starting point of surveillance might improve the prognosis of young patients with HCC. However, a matter of cost-effectiveness should also be considered, which necessitates a further analysis on this issue.

Case Reports

A Case of Hepatocellular Carcinoma in Young Age Younger than 20 Years Old: Joo Won Chung, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon, Geung-kyu Ko, Jin Sil Seong, Jong Hee Chang, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):71-75. Published online June 30, 2009

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Abstract PDF: Hepatocellular carcinoma (HCC) is very rare in young age. Most young patients tend to receive the evaluation only when they experience intractable or persistent symptoms. Therefore, HCC in young patients is often diagnosed at advanced stage and thus, young HCC patients have a worse prognosis than older HCC. However, because young HCC patients show well-preserved liver function than older HCC, they are tolerable to more aggressive treatments. We report a case of advanced HCC in 13-year and 8-month old male who has been a B-viral carrier. Despite the tumor size decreased after concurrent chemoradiation therapy, multiple lung and brain metastases developed. He underwent radiofrequency ablations on lung metastases and gamma-knife surgery on brain metastasis, and he has received systemic and intra-arterial chemotherapy. The screening and early diagnosis of HCC in young age is needed especially for B-viral carrier with a family history of HCC.

A Case of Advanced Hepatocellular Carcinoma in Twenties Treated by Multimodality Therapy: Jang Eun Lee, Na Ri Yoon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Dong Goo Kim, Ho Jong Chun, Byung Gil Choi, Hae Giu Lee, Hong Seok Jang, Chan Kwon Jung, Eun Sun Jang; Journal of the Korean Liver Cancer Study Group. 2009;9(1):82-85. Published online June 30, 2009

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Abstract PDF: The prognosis of young patients with hepatocellular carcinoma is remains controversial. Here we report a case of advanced hepatocellular carcinoma in twenty, successfully treated with transarterial chemolipidolization (TACL), systemic chemotherapy, radiation therapy and surgical resection. Previously healthy 28 years old woman was admitted for treatment of hepatocellular carcinoma. Abdominal CT showed a diffuse infiltrative HCC involving both lobes with intrahepatic bile duct invasion and pericardial lymphadenopathy. She was treated TAC with systemic chemotherapy and external beam radiotherapy. 6 months after these treatments, main tumor and the pericardial lymph node were decreased in size. And then extended left lobectomy and systemic chemotherapy were done. The pericardial lymph node was markedly decreased. The patient has been followed for 10 months without evidence of regional tumor recurrence.

A Case of Hepatocellular Carcinoma with Rib Metastasis in a Young Patient in Twenties: Seung Young Kim, Hyung Joon Yim, Jae Hong Ahn, Sung Woo Jung, Jeong Han Kim, Ji Hoon Kim, Ju-Han Lee, Seung Hwa Lee, Hwan Hoon Chung, jong Eun Yeon, Hong Sik Lee, Sang Woo Lee, Kwan Soo Byun, Jai Hyun Choi; Journal of the Korean Liver Cancer Study Group. 2009;9(1):86-89. Published online June 30, 2009

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Abstract PDF: Helatocellular carcinoma (HCC) is uncommon in young adults, and young HCC patients is known to show poor prognosis than older HCC patients because they have a more advanced tumor stage at diagnosis. We describe a case of HCC in a 28-year old chronic hepatitis B virus carrier who showed multiple nodular HCC with bone metastasis at diagnosis. In spite of multidisciplinary treatment including transarterial chemoembolization (TACE) for liver mass and radiotherapy for metastatic bone lesion, the patient died of cancer progression and weakened general condition 15 months after diagnosis. Therefore, we need to consider periodic surveillance in young chronic hepatitis B virus carriers.

A Case of Hepatocellular Carcinoma in a Young Patient with Suspected Autoimmune Hepatitis: Yu Jin Kim, Sang Hoon Park, Kyung Rim Huh, Kyung Hoon Lee, Tae Ho Hahn, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Min Jeong Kim, Soo Ki Min; Journal of the Korean Liver Cancer Study Group. 2009;9(1):94-97. Published online June 30, 2009

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Abstract PDF: Whether the prognosis of hepatocellular carcinoma in young patients is different from elderly patients is still controversial. Previous reports revealed that most of the young hepatocellular carcinoma patients have hepatitis B viral infection, larger tumor and more advanced stage than elderly patients, and these features not just young age are related with poor survival. We experienced a case of stage IVA hepatocellular carcinoma suspected to be related with autoimmune hepatitis in a 28-year-old man. Even though 3 times of transarterial chemoembolization and best supportive care were given, he died 7 months after diagnosis.

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