The prognosis of elderly patients with hepatocellular carcinoma after curative hepatectomy a multicenter competing risk analysis - 11/08/23
, Wen.Feng Lu c, Jian Cheng b, Wei.Feng Yao b, Ya.Ming Xie b, Dong.Dong Wang b, Fei.Qi Xu b, Zun.Qiang Xiao b, Jun.Gang Zhang b, Jun.Wei Liu b, Cheng.Wu Zhang b, Dong.Sheng Huang a, b, d, ⁎ Highlights |
• | The impact of non-cancer-specific death needs concern when elucidating survival benefits from curative liver resection among patients with hepatocellular carcinoma. |
• | After adjustment for other confounding risks on multivariate competing-risk regression analyses, age was independently associated with non-cancer-specific death, but neither was associated with recurrence nor cancer-specific death. |
• | For patients undergoing curative liver resection for early-stage HCC, older age was independently associated with non-cancer-specific death, but not recurrence and cancer-specific death. |
Abstract |
Background |
Non-cancer-specific death (NCSD) is an important factor that needs to be considered in patients with malignancy, as it can affect their long-term prognosis. In particular, the effect of age on patients with hepatocellular carcinoma (HCC) after hepatectomy requires clarification. This study aims to examine the impact of age on patients with HCC after hepatectomy and to identify independent risk factors of survival.
Methods |
Patients with HCC that fell within the Milan Criteria and had undergone curative hepatectomy were included in this study. The patients were divided into two groups: young patients (age <70) and elderly patients (age ≥70). Perioperative complications, cancer-specific death (CSD), recurrence, and NCSD were all recorded and analyzed. Multivariate analyses were performed to identify independent risk factors of survival using Fine and Gray's competing-risk regression model.
Results |
Among 1,354 analytic patients, 1,068 (78.7%) were stratified into the young group and 286 (21.3%) into the elderly group. The elderly group had a higher 5-year cumulative incidence of NCSD (12.6% vs. 3.7% for the young group, P < 0.001), but lower 5-year cumulative incidences of recurrence (20.3% vs. 21.1% for the young group, P = 0.041) and CSD (14.3% vs. 15.5% for the young group, P = 0.066). Multivariate competing-risk regression analyses revealed that age was independently associated with NCSD (subdistribution hazard ratio (SHR) 3.003, 95%CI: 2.082–4.330, P < 0.001), but not with recurrence (SHR 0.837, 95%CI: 0.659–1.060, P = 0.120) or CSD (SHR 0.736, 95%CI: 0.537–1.020, P = 0.158).
Conclusion |
For patients with early-stage HCC after hepatectomy, older age was independently associated with NCSD, but not recurrence and CSD.
Le texte complet de cet article est disponible en PDF.Keywords : Hepatocellular carcinoma, Elderly, Recurrence, Cancer-specific death, Competing risk analysis
Abbreviations : HCC, SHR, CI, HBV, HCV, ALT, AST, AFP
Plan
Vol 47 - N° 7
Article 102147- août 2023 Retour au numéro
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