Hepatocellular carcinoma in old age: are there any benefits of liver resection in old age?

다국어 초록 (Multilingual Abstract)

Purpose: Elderly individuals have comorbidities that can adversely affect surgical outcomes. Some studies reported that elderly patients with hepatocellular carcinoma (HCC) have higher liver- and non-liver–related deaths. Therefore, palliative treatments are preferred in these patients. We compared surgical treatment outcomes between young and old age groups.
Methods: In total, 233 liver resections were performed in patients with HCC from March 2012 to December 2018. We retrospectively reviewed medical records. The old age group was defined as patients aged more than 70 years. We compared perioperative characteristics and surgical outcomes and analyzed the prognostic factors for disease-free survival (DFS) and overall survival (OS) rates.
Results: The young and old age group included 184 and 49 patients, respectively. Preoperative characteristics were similar. Major liver resection rate was similar (young age group, 26.1% vs. old age group, 20.4%), but the operation time was a little bit shorter in old age group. Major postoperative complications were 23 (12.5%) and 9 (18.4%) in the young and old age group (P = 0.351). Median non-liver–related overall survival were 80 and 76 months (P = 0.889) and liver-related OS were 76 and 76 months (P = 0.514) in the young and old age groups, respectively. Age was not an independent risk factor for DFS and OS.
Conclusion: Elderly patients showed similar non-liver- and liver-related OS rates as young patients after liver resection.
Postoperative complications were also similar. If elderly patients are well selected, they can receive curative treatment and show good surgical outcomes.

참고문헌 (Reference)

1 Lim JH, "Ventral segment-preserving right hepatectomy in patients with hepatocellular carcinoma" 39 : 1034-1043, 2015

2 안상현, "The optimal follow-up period in patients with above 5-year disease-free survival after curative liver resection for hepatocellular carcinoma" 대한외과학회 85 (85): 269-274, 2013

3 Turrentine FE, "Surgical risk factors, morbidity, and mortality in elderly patients" 203 : 865-877, 2006

4 Inoue Y, "Surgical outcome and hepatic regeneration after hepatic resection for hepatocellular carcinoma in elderly patients" 36 : 289-301, 2019

5 Ramesh H, "Resection for hepatocellular carcinoma" 4 (4): S90-S96, 2014

6 Ide T, "Prediction of postoperative complications in elderly patients with hepatocellular carcinoma" 185 : 614-619, 2013

7 Hammad AY, "Palliative interventions for hepatocellular carcinoma patients : analysis of the National Cancer Database" 6 : 26-35, 2017

8 Bulathsinhala BKS, "Outcome of hepatic resection : First fiveyear experience in elderly and younger patients" 63 : 43-45, 2018

9 Yamada S, "Outcome of hepatectomy in super-elderly patients with hepatocellular carcinoma" 42 : 454-458, 2012

10 Mastoraki A, "Outcome following major hepatic resection in the elderly patients" 38 : 462-466, 2014

11 Jung M, "National Cancer Screening Programs and evidence-based healthcare policy in South Korea" 119 : 26-32, 2015

12 Dahiya D, "Minor versus major hepatic resection for small hepatocellular carcinoma(HCC)in cirrhotic patients : a 20-year experience" 147 : 676-685, 2010

13 National Cancer Information Center, "Major cancer mortality" National Cancer Information Center

14 Ruzzenente A, "Impact of age on short-term outcomes of liver surgery: lessons learned in 10-years’ experience in a tertiary referral hepato-pancreato-biliary center" 96 : e6955-, 2017

15 Kaibori M, "Impact of advanced age on survival in patients undergoing resection of hepatocellular carcinoma : report of a Japanese nationwide survey" 269 : 692-699, 2019

16 Guo H, "Hepatocellular carcinoma in elderly : clinical characteristics, treatments and outcomes compared with younger adults" 12 : e0184160-, 2017

17 Zarour LR, "Hepatic resection of solitary HCC in the elderly : a unique disease in a growing population" 217 : 899-905, 2019

18 Zhao LY, "Hepatic resection for elderly patients with hepatocellular carcinoma : a systematic review of more than 17, 000 patients" 12 : 1059-1068, 2018

19 de la Fuente SG, "Funct ional status determines postoperative outcomes in elderly patients undergoing hepatic resections" 107 : 865-870, 2013

20 Hamaoka M, "Evaluation of the risk factors and prognostic factors of hepatectomy for hepatocellular carcinoma in patients aged 80 years or more" 24 : 58-64, 2017

21 Santambrogio R, "Effect of age(over 75 years)on postoperative complications and survival in patients undergoing hepat ic resection for hepatocellular carcinoma" 21 : 657-665, 2017

22 Cucchetti A, "Effect of age on survival in patients undergoing resection of hepatocellular carcinoma" 103 : e93-e99, 2016

23 Kim SH, "Early predictor of mortality due to irreversible posthepatectomy liver failure in patients with hepatocellular carcinoma" 37 : 1028-1033, 2013

24 Wei F, "Does an extreme age(≥80 years)affect outcomes in patients after liver cancer surgery? A meta-analysis" 89 : 25-31, 2019

25 장재승, "Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status" 대한위암학회 13 (13): 247-254, 2013

26 Kutlu OC, "Comparative effectiveness of first-line radiofrequency ablation versus surgical resection and transplantation for patients with early hepatocellular carcinoma" 123 : 1817-1827, 2017

27 Tan JT, "Association between age and overall survival of patients with hepatocellular carcinoma after hepatic resection" 114 : 966-970, 2016

28 Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC, "2018 Korean Liver Cancer Association–National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma" 거트앤리버 소화기연관학회협의회 13 (13): 227-299, 2019