Factors associated with the overall survival of elderly patients with hepatocellular carcinoma

AIM:To identify the factors associated with overall survival of elderly patients with hepatocellular carcinoma(HCC).METHODS:A total of 286 patients with HCC(male/female:178/108,age:46-100 years),who were diagnosed and treated by appropriate therapeutic procedures between January 2000 and December 2010,were enrolled in this study.Patients were stratified into two groups on the basis of age:Elderly(≥ 75 years old) and non-elderly(< 75 years old).Baseline clinical characteristics as well as cumulative survival rates were then compared between the two groups.Univariate and multivariate analyses were used to identify the factors associated with prolonged overall survival of patients in each group.Cumulative survival rates in the two groups were calculated separately for each modified Japan Integrated Stage score(mJIS score) category by the Kaplan-Meier method.In addition,we compared the cumulative survival rates of elderly and non-elderly patients with good hepatic reserve capacity(≤ 2 points as per mJIS).RESULTS:In the elderly group,the proportion of female patients,patients with absence of hepatitis B or hepatitis C viral infection,and patients with coexisting extrahepatic comorbid illness was higher(56.8% vs 31.1%,P < 0.001;27.0% vs 16.0%,P = 0.038;33.8% vs 22.2%,P = 0.047;respectively) than that in the nonelderly group.In the non-elderly group,the proportion of hepatitis B virus(HBV)-infected patients was higher than that in the elderly group(9.4% vs 0%,P = 0.006).The cumulative survival rates in the elderly group were 53.7% at 3 years and 32.9% at 5 years,which were equivalent to those in the non-elderly group(55.9% and 39.4%,respectively),as shown by a log-rank test(P = 0.601).In multivariate analysis,prolonged survival was significantly associated with the extent of liver damage and stage(P < 0.001 and P < 0.001,respectively),but was not associated with patient age.However,on individual evaluation of factors in both groups,stage was significantly(P < 0.001) associated with prolonged survival.Regarding mJIS scores of ≤ 2,the rate of female patients with this score was higher in the elderly group when compared to that in the non-elderly group(P = 0.012) and patients ≥ 80 years of age tended to demonstrate shortened survival.CONCLUSION:Survival of elderly HCC patients was associated with liver damage and stage,but not age,except for patients ≥ 80 years with mJIS score ≤ 2.

Case of autoimmune hepatitis with markedly enlarged hepatoduodenal ligament lymph nodes

Autoimmune hepatitis(AIH) is a necroinflammatory liver disease of unknown etiology.The disease is characterized histologically by interface hepatitis,biochemically by increased aspartate aminotransferase and alanine aminotransferase levels,and serologically by increased autoantibodies and immunoglobulin G levels.Here we discuss AIH in a previously healthy 37-year-old male with highly elevated serum levels of soluble interleukin-2 receptor and markedly enlarged hepatoduodenal ligament lymph nodes(HLLNs,diameter,50 mm).Based on these observations,the differential diagnoses were AIH,lymphoma,or Castleman's disease.Liver biopsy revealed the features of interface hepatitis without bridging fibrosis along with plasma cell infiltration which is the typical characteristics of acute AIH.Lymph node biopsy revealed lymphoid follicles with inflammatory lymphocytic infiltration;immunohistochemical examination excluded the presence of lymphoma cells.Thereafter,he was administered corticosteroid therapy:after 2 mo,the enlarged liver reached an almost normal size and the enlarged HLLNs reduced in size.We could not find AIH cases with such enlarged lymph nodes(diameter,50 mm) in our literature review.Hence,we speculate that markedly enlarged lymph nodes observed in our patient may be caused by a highly activated,humoral immune response in AIH.