Clinical Analysis Of One Hundred And Seventy-Seven Patients Below 40 Years Old With Primary Hepatic Cancer Associated With Liver Cirrhosis Due To Hepatitis B

Objective:To summarize the clinical characteristics of patients below 40 years old with primary hepatic cancer (PHC)associated with liver cirrhosis due to hepatitis B, and to explore the strategies of diagnosis and treatment retrospectively .Methods: The clinical data of 177 cases were reviewed which were below 40years old and had PHC associated with liver cirrhosis due to hepatitis B from January 2001 to October 2010 in the first affiliated hospital of Guangxi Medical University.Results: One hundred and seventy-seven patients were included in this paper, account for 14.1% of total amount inpatients with PHC at the same time. The data indicated that male patients were account for 92.7 %, the proportion of male and female was 12.62︰1.The median age was 35yeas old, and 30～39 years old was the age vulnerable(84.2 %). There were 92 patients with a definite history of hepatitis B(52.0%). The illness courses were from 1 to 24years, average 9.9 years. There were 20 patients with a PHC family history(11.3%). There were variable kinds of clinical manifestations in these patients, mainly right upper abdominal pain (59.3%), hepatomegaly(33.3%), hypodynamia and symptosis(29.4%), ascites(19.2%). Detection of serum hepatitis B virus markers indicated that the positive rate of HBsAg,anti-HBe,anti-HBc was 60.9%. The positive rate of serum AFP was 84.5%. Results of CT and MRI indicated that massive type was the mainly morphology of PHC(48.5%). There were 18 cases of small liver cancer(13.4%). There were 32 cases PHC with portal vein tumor thrombosis(25%). The number of patients who received surgery resection and liver transplantation were 68 and 2 cases, respectively, operability rate was 39.5%. The pathology after surgery was predominantly hepatocellular carcinoma(HCC, 95.6%), and Edmondson-Steiner gradeⅡwas common in tumor differentiation diagnosis.Conclusions: Most patients with PHC below 40 years old associated with liver cirrhosis due to hepatitis B are male, right upper abdominal pain,hepatomegaly, hypodynamia and symptosis, ascites are the most common manifestations, massive type is the mainly morphology type of PHC and portal vein tumor thrombosis is common, operability rate is low. The patients with low level or negative serum AFP should be paid more attention for PHC diagnosis.