Impact of aging on the development of hepatocellular carcinoma in patients with hepatitis C virus infection in Japan

Background: It is difficult to study the long-term outcome of hepatitis C virus (HCV) infection because chronic infection is often asymptomatic and duration of the disease is prolonged. The clinical outcome of HCV infection remains unclear in patients of advanced age. Methods: Among 575 patients consecutively diagnosed with hepatocellular carcinoma (HCC) from 1988 to 1999 at Hiroshima University, we examined 430 with HCV. We studied the differences between males and females in the following characteristics: age at first diagnosis of HCC, Child grade, various tumour factors, history of blood transfusion, duration to development of HCC, and history of alcohol intake. Results: The incidence of HCC patients with HCV increased in elderly persons, including female patients. Background liver function was significantly better for female patients ( P < 0.001). In both genders, the duration between blood transfusion and diagnosis of HCC was significantly shorter when the patients received blood transfusion at an older age ( P < 0.001). In habitual drinkers, the average age at first diagnosis of HCC was significantly younger ( P < 0.001), and duration to development of HCC significantly shorter ( P < 0.05). The percentage of atomic bomb survivors among HCV-positive HCC patients was significantly higher than that among HCV-negative HCC patients ( P < 0.05). Conclusions: Patients with HCV might exhibit slow disease progression and develop HCC finally with aging regardless of gender. Patients of advanced age with HCV, even female patients, should therefore be closely followed.