1
|
Zhou L, Zhang Y, Zheng J, Ruan M, Zhang J, Li Y, Jin R, Wu D, Sun H, Zhang J, Wang R. Discontinuation of immune checkpoint inhibitors in hepatocellular carcinoma: a retrospective cohort study. J Gastrointest Oncol 2024; 15:1698-1711. [PMID: 39279966 PMCID: PMC11399828 DOI: 10.21037/jgo-24-216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/18/2024] [Indexed: 09/18/2024] Open
Abstract
Background The optimal timing to discontinue immune checkpoint inhibitor (ICI) therapy in hepatocellular carcinoma (HCC) patients with clinical benefits remains unclear. This study aimed to assess the outcomes of HCC patients after ICI discontinuation. Methods Patients with HCC were retrospectively screened and those discontinued ICI therapy in the absence of progressive disease (PD) were included. Responses at discontinuation were evaluated per response evaluation criteria in solid tumors (RECIST) version 1.1 and modified RECIST (mRECIST). Patients were classified into five subgroups according to the cause of discontinuation: complete response (CR), partial response (PR), stable disease (SD) per RESICT version 1.1, adverse event (AE), or others. Progression-free survival (PFS) and overall survival (OS) since ICI start or after ICI discontinuation were assessed. Results A total of 66 patients were included. The median follow-up was 29.33 months. The median PFS since ICI start was 30.83 months [95% confidence interval (CI): 24.93-36.72], and the median OS was not reached. The median PFS after discontinuation was 20.6 months (95% CI: 7.63-33.56), and the median OS after discontinuation was not reached. Univariate analysis showed that age, treatment after discontinuation, Response (RECIST version 1.1) at discontinuation and modified response (mResponse per mRECIST) at discontinuation were significantly associated with PFS after discontinuation, while age and mResponse at discontinuation were significantly associated with OS after discontinuation. Multivariate analysis further demonstrated that mResponse at discontinuation and treatment after discontinuation were independently associated with PFS after discontinuation, while age was independently associated with OS after discontinuation. Conclusions ICIs might be discontinued in HCC patients with a response of CR per mRECIST. Patients with a response of PR/SD per mRECIST or elder age could continue ICI therapy after achieving clinical benefits. Tyrosine kinase inhibitor (TKI) maintenance therapy might help to prevent progression after ICI discontinuation.
Collapse
Affiliation(s)
- Liuyu Zhou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| | - Yuhong Zhang
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zheng
- Department of Laboratory Diagnostics, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Minghao Ruan
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| | - Jin Zhang
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| | - Yao Li
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| | - Riming Jin
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| | - Dong Wu
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| | - Hanyong Sun
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Zhang
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyu Wang
- The First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Naval Medical University, Shanghai, China
| |
Collapse
|
2
|
Lee JS, Park DA, Ryoo S, Park J, Choi GH, Yoo JJ. Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Gut Liver 2024; 18:695-708. [PMID: 38712397 PMCID: PMC11249930 DOI: 10.5009/gnl230485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : With increased life expectancy, the management of elderly hepatocellular carcinoma (HCC) patients became a crucial issue, yet it is still challenging due to comorbidities and high surgical risks. While surgical resection is considered as primary treatment for eligible HCC patients, systematic evidence on its outcomes in elderly patients remains scarce. In this review, we aimed to analyze the efficacy and safety outcomes of surgical resection in elderly HCC patients. Methods : The studies included in this meta-analysis were selected from Ovid-MEDLINE, Ovid-Embase, CENTRAL, KoreaMed, KMbase, and KISS databases following a predefined protocol. Efficacy outcomes included overall survival and disease-free survival, while the safety outcomes included postoperative mortality and complications. Results : Patients in the elderly group (≥65 years) who underwent surgery exhibited non-inferior overall survival (hazard ratio [HR], 1.26; 95% confidence interval [CI], 0.92 to 1.74) and disease-free survival (HR, 1.03; 95% CI, 0.99 to 1.08) compared to the non-elderly group. Overall postoperative mortality exhibited no statistical difference (odds ratio [OR], 1.07; 95% CI, 0.87 to 1.31), but 30-day, 90-day, and in-hospital mortality were higher in the elderly group. The incidence of overall complications was higher in the elderly group (OR, 1.44; 95% CI, 1.22 to 1.69). Sensitivity analysis for the super elderly group (≥80 years) showed significantly higher in-hospital mortality compared to the non-super elderly group (OR, 2.51; 95% CI, 1.16 to 5.45). Conclusions : The efficacy outcome of surgical resection in the elderly HCC patients was not worse than that in the non-elderly HCC patients, while in-hospital mortality and complications rates were higher. Therefore, surgical resection should be purposefully considered in the elderly population, with careful candidate selection.
Collapse
Affiliation(s)
- Jin-Soo Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Asan, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seungeun Ryoo
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Gi Hong Choi
- Department of General Surgery, Yonsei University School of Medicine, Seoul, Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Asan, Korea
| |
Collapse
|
3
|
Yoo JJ, Koo S, Choi GH, Lee MW, Ryoo S, Park J, Park DA. Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Curr Oncol 2024; 31:324-334. [PMID: 38248106 PMCID: PMC10813859 DOI: 10.3390/curroncol31010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Although the disease burden of elderly cancer patients is rapidly increasing, reliable scientific information, value and preference information of domestic patients, and standardized guidelines for determining the treatment of elderly cancer patients are lacking. The aim of this study is to compare the therapeutic effects of radiofrequency ablation (RFA) and surgery in hepatocellular carcinoma (HCC) patients aged 65 years or older. For the meta-analysis, the databases including PubMed (MEDLINE), EMBASE, OVID Medline, and the Cochrane Library were systematically searched. After the abstract-based review by two investigators, selected manuscripts were read in detail. The surgery group showed higher overall survival (OS) (HR 1.44, 95% CI 1.22-1.70) and disease-free survival (DFS) (HR 1.40, 95% CI 1.00-1.97) than the RFA group. This was also shown in small HCC of less than 3 cm (OS, HR 1.42, 95% CI 1.00-2.03; DFS, HR 1.32, 95% CI 0.91-1.91). This might be related to the high local recurrence in the RFA group (OR 4.90, 95% 2.16-11.08). On the other hand, adverse events were significantly lower in the RFA group (OR 0.22, 95% CI 0.14-0.36), which led to a decrease in the duration of hospital stay (mean difference -14.88 days, 95% CI -22.44--7.32). In elderly HCC patients, survival in the surgery group was significantly higher than in the RFA group, but various complications tended to increase; so, appropriate patient selection is required.
Collapse
Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea;
| | - Sujin Koo
- Graduate School of Converging Clinical and Public Health, Ewha Womans University, Seoul 03760, Republic of Korea;
| | - Gi Hong Choi
- Department of General Surgery, Yonsei University School of Medicine, Seoul 03722, Republic of Korea;
| | - Min Woo Lee
- Department of Radiology, Samgsung Medical Center, Sungkyunkwan University, Seoul 06171, Republic of Korea;
| | - Seungeun Ryoo
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea; (S.R.); (J.P.)
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea; (S.R.); (J.P.)
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea; (S.R.); (J.P.)
| |
Collapse
|
4
|
Wong LL, Lee LY, Karasaki K, Ogihara M, Tran C. Management of hepatocellular carcinoma in patients who are 70 years or older. Surg Open Sci 2022; 10:53-58. [PMID: 35993004 PMCID: PMC9386461 DOI: 10.1016/j.sopen.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although liver transplantation has been done successfully in elderly patients with hepatocellular carcinoma, these are likely well-selected patients. This study uses a large database of patients with hepatocellular carcinoma to explore treatment and potential candidacy for liver transplantation in the elderly. Methods Retrospective review of 1,533 hepatocellular carcinoma cases identified 2 groups: 475 patients 70 years or older (70 +) and 1,058 patients < 70 years. Demographics, risk factors, tumor characteristics, treatments, and survival were compared. Three- and 5-year survival rates were determined, and logistic regression was used to identify factors predictive of 3-year survival. Results Patients 70 + were more likely to have metabolic factors and less likely to have viral hepatitis, cirrhosis, hepatocellular carcinoma found with surveillance (21.7% vs 28.4%, P = .005), and hepatocellular carcinoma within Milan criteria (37.3% vs 43.8%, P = .019). Model for End-stage Liver Disease score was similar, but patients 70 + had higher mean creatinine and lower mean bilirubin. Patients 70 + were equally likely to undergo liver resection but less likely to undergo liver transplantation (0.4% vs 10.2%, P < .001). Three- and 5-year survival rates were significantly worse in 70 +, and predictors of 3-year survival included hepatocellular carcinoma found with surveillance, meeting Milan criteria, and normal alpha fetoprotein. Discussion Elderly patients with hepatocellular carcinoma were less likely to undergo liver transplantation potentially due to metabolic factors and advanced disease. Although there is no age cutoff for liver transplantation, elderly patients should be given realistic expectations of liver transplantation candidacy. Continued surveillance for hepatocellular carcinoma in elderly patients may allow for earlier diagnosis and improved liver transplantation candidacy. Key Message Hepatocellular carcinoma in patients who are 70 years or older can be managed with liver transplantation in select cases, but more patients will be managed with liver resection and nonoperative therapies. Most patients with hepatocellular carcinoma who are older than 70 years will not undergo liver transplant. Older patients are more likely to have metabolic risk factors and comorbidities including diabetes, hypertension, hyperlipidemia, and nonalcoholic steatohepatitis. Older patients have similar Model for End-stage Liver Disease score as younger patients; their scores are based on having more renal dysfunction and a lower bilirubin. Older patients are less likely to have their hepatocellular carcinoma found with surveillance and are more likely to have cancer that is beyond Milan criteria which are generally used for transplant candidacy.
Collapse
Affiliation(s)
- Linda L. Wong
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine, 1356 Lusitana St, 6th Floor, Honolulu, HI 96813
- Corresponding author at: 550 S Beretania St, Suite 403, Honolulu, Hawaii 96813. 808-523-5033 (business phone), 808-523-0166 (home phone); fax: 808-528-4940.
| | - Lung Yi Lee
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine, 1356 Lusitana St, 6th Floor, Honolulu, HI 96813
| | - Kameko Karasaki
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine, 1356 Lusitana St, 6th Floor, Honolulu, HI 96813
| | - Makoto Ogihara
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine, 1356 Lusitana St, 6th Floor, Honolulu, HI 96813
| | - Chuong Tran
- Department of Medicine, University of Hawaii, John A. Burns School of Medicine, 1356 Lusitana St, 7th Floor, Honolulu, HI 96813
| |
Collapse
|
5
|
Fründt TW, Casar C, von Felden J, Schöler U, Priebe M, Kraczyk J, Ahrend H, Salamon J, Adam G, Huber S, Lohse AW, Wege H, Schulze K. Equal Efficacy and Safety Profile in Elderly Patients with Hepatocellular Carcinoma Receiving Palliative Treatment. Cancers (Basel) 2022; 14:768. [PMID: 35159035 PMCID: PMC8833746 DOI: 10.3390/cancers14030768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Palliative treatment of elderly patients with hepatocellular carcinoma (HCC) is often challenging due to comorbidities or frailty, and data about the outcome and overall survival (OS) in these patients are limited. This was a retrospective single centre study. Patients were grouped according to their age as young (<60 years; YP), intermediate (60-70 years; IP) or elderly (>70 years; EP). Administration of chemotherapy or transarterial chemoembolization (TACE) was defined as palliative treatment. Therapy-related adverse events (AE) were assessed via CTCAE 5.0. Out of 656 patients analyzed, n = 359 received palliative treatment: YP: n = 90; IP: n = 127 and EP: n = 142. The median OS (months) in patients receiving TACE (n = 254) was 17 vs. 18 vs. 20 months for YP, IP, and EP, respectively (p = 0.44) and 15 vs. 16 vs. 17 months (p = 0.56), respectively, in patients receiving chemotherapy (n = 105). AEs differed non-significantly between the subgroups. Multivariate analysis revealed impaired liver function and advanced tumor stage as significant factors for impaired OS. In this study, the mOS and rate of AEs were equal between elderly and younger HCC patients receiving palliative treatment. Therefore, we propose regular palliative treatment stratification in spite of the high age of patients.
Collapse
Affiliation(s)
- Thorben W. Fründt
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| | - Christian Casar
- Bioinformatics Facility, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.C.); (J.K.)
| | - Johann von Felden
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| | - Ulrike Schöler
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| | - Maximilian Priebe
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| | - Jenny Kraczyk
- Bioinformatics Facility, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.C.); (J.K.)
| | - Hannes Ahrend
- Department of Internal Medicine, Israelitic Hospital, 22297 Hamburg, Germany;
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.); (G.A.)
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.S.); (G.A.)
| | - Samuel Huber
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| | - Ansgar W. Lohse
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| | - Henning Wege
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
- Cancer Center Esslingen, Klinikum Esslingen, 73730 Esslingen am Neckar, Germany
| | - Kornelius Schulze
- I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.v.F.); (U.S.); (M.P.); (S.H.); (A.W.L.); (H.W.); (K.S.)
| |
Collapse
|
6
|
He T, Chen T, Liu X, Zhang B, Yue S, Cao J, Zhang G. A Web-Based Prediction Model for Cancer-Specific Survival of Elderly Patients With Early Hepatocellular Carcinoma: A Study Based on SEER Database. Front Public Health 2022; 9:789026. [PMID: 35096742 PMCID: PMC8792840 DOI: 10.3389/fpubh.2021.789026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Primary liver cancer is a common malignant tumor primarily represented by hepatocellular carcinoma (HCC). The number of elderly patients with early HCC is increasing, and older age is related to a worse prognosis. However, an accurate predictive model for the prognosis of these patients is still lacking. Methods: Data of eligible elderly patients with early HCC in Surveillance, Epidemiology, and End Results database from 2010 to 2016 were downloaded. Patients from 2010 to 2015 were randomly assigned to the training cohort (n = 1093) and validation cohort (n = 461). Patients' data in 2016 (n = 431) was used for external validation. Independent prognostic factors were obtained using univariate and multivariate analyses. Based on these factors, a cancer-specific survival (CSS) nomogram was constructed. The predictive performance and clinical practicability of our nomogram were validated. According to the risk scores of our nomogram, patients were divided into low-, intermediate-, and high-risk groups. A survival analysis was performed using Kaplan–Meier curves and log-rank tests. Results: Age, race, T stage, histological grade, surgery, radiotherapy, and chemotherapy were independent predictors for CSS and thus were included in our nomogram. In the training cohort and validation cohort, the concordance indices (C-indices) of our nomogram were 0.739 (95% CI: 0.714–0.764) and 0.756 (95% CI: 0.719–0.793), respectively. The 1-, 3-, and 5-year areas under receiver operating characteristic curves (AUCs) showed similar results. Calibration curves revealed high consistency between observations and predictions. In external validation cohort, C-index (0.802, 95%CI: 0.778–0.826) and calibration curves also revealed high consistency between observations and predictions. Compared with the TNM stage, nomogram-related decision curve analysis (DCA) curves indicated better clinical practicability. Kaplan–Meier curves revealed that CSS significantly differed among the three different risk groups. In addition, an online prediction tool for CSS was developed. Conclusions: A web-based prediction model for CSS of elderly patients with early HCC was constructed and validated, and it may be helpful for the prognostic evaluation, therapeutic strategy selection, and follow-up management of these patients.
Collapse
Affiliation(s)
- Taiyu He
- Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
- Institute for Viral Hepatitis, Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyao Chen
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Biqiong Zhang
- Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
- Institute for Viral Hepatitis, Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Song Yue
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junyi Cao
- Department of Record Room, Zigong First People's Hospital, Zigong, China
| | - Gaoli Zhang
- Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
- Institute for Viral Hepatitis, Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Gaoli Zhang
| |
Collapse
|
7
|
Rho SY, Lee HW, Kim DY, Kim KS. Current Status of Therapeutic Choice and Feasibility for Patients with Hepatocellular Carcinoma Aged ≥ 70 Years: A Nationwide Cancer Registry Analysis. J Hepatocell Carcinoma 2021; 8:321-332. [PMID: 33959557 PMCID: PMC8096455 DOI: 10.2147/jhc.s306507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background The opportunities for examining elderly patients with hepatocellular carcinoma (HCC) have increased. We investigated the treatment of HCC for elderly patients and the overall survival associated with each treatment modality. Methods From January 2003 to December 2005 (n=578, period I) and January 2008 to December 2014 (n=2428, period II), the National Cancer Center and Korean Liver Cancer Association collected clinical data of 3006 patients with HCC aged ≥70 years old at 54 medical centers in Korea. We analyzed the treatment modalities and overall survival for patients with HCC aged ≥70 years. Results The mean age, Child-Pugh score, and model for end-stage liver disease score and proportion of male patients were not different between period I and period II (74 years, 6.6, 10.4 and 70.1% vs 76 years, 6.2, 9.9 and 67.3%). TNM stage II and BCLC stage A were most commonly noted in periods I and II (44.3% and 49.1% vs 40.4% and 40.2%). Transarterial therapy was the most commonly used treatment modality according to age in both periods. Surgical resection was associated with significant superior overall survival compared to local ablation and transarterial therapy (p<0.001). After propensity score matching between surgical resection and transarterial therapy in period II, surgical resection was associated with more favorable overall survival outcomes (median: 39 months vs 86 months, p<0.001). Conclusion Transarterial therapy was the most commonly used treatment modality for patients with HCC aged ≥70 years. However, surgical resection led to significantly higher overall survival rates compared to other treatment modalities.
Collapse
Affiliation(s)
- Seoung Yoon Rho
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,The Korean Liver Cancer Association, Seoul, Korea
| | - Hyun Woong Lee
- The Korean Liver Cancer Association, Seoul, Korea.,Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- The Korean Liver Cancer Association, Seoul, Korea.,Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- The Korean Liver Cancer Association, Seoul, Korea.,Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Federico P, Giunta EF, Pappalardo A, Tufo A, Marte G, Attademo L, Fabbrocini A, Petrillo A, Daniele B. How to Treat Hepatocellular Carcinoma in Elderly Patients. Pharmaceuticals (Basel) 2021; 14:233. [PMID: 33800217 PMCID: PMC8001824 DOI: 10.3390/ph14030233] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of "elderly" and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.
Collapse
Affiliation(s)
- Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Emilio Francesco Giunta
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Annalisa Pappalardo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Andrea Tufo
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Gianpaolo Marte
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Laura Attademo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Antonietta Fabbrocini
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| |
Collapse
|
9
|
Harada M, Aramaki O, Midorikawa Y, Higaki T, Nakayama H, Moriguchi M, Takayama T. Impact of patient age on outcome after resection for hepatocellular carcinoma. Biosci Trends 2021; 15:33-40. [PMID: 33551417 DOI: 10.5582/bst.2020.03437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is little information on the impact of aging on liver resection of hepatocellular carcinoma (HCC). The aim of study was to evaluate the prognostic impact of the patient's age on the long-term survival after resection of HCC. The postoperative outcomes of the 291 elderly (≥ 70 years) and 340 younger (< 70 years) patients underwent curative liver resection for HCC were analyzed using multivariate and propensity-score matching. Risk score were calculated from the results of Cox regression analysis. The overall survival rate was significantly lower in the elderly group than that in the younger group (p = 0.01). Factors related to overall survival were vascular invasion (absent vs. present, HR 2.25; 95% CI 1.52-3.33, p = 0.0001), albumin level (< 3.0 vs. ≥ 3.0 g/dl, HR 2.23; 95% CI 1.31-3.79, p = 0.003), and number of tumors (solitary vs. multiple, HR 1.68; 95% CI 1.24-2.27, p = 0.001). The results of risk-score analysis with a Cox proportional-hazards model indicated that the proportion of poor-risk patients was significantly higher in the elderly than in the younger group. Propensity-score matching analysis yielded 234 pairs of patients. There were no significant differences in baseline profiles or risk scores between the two groups (p = 0.43). There were also no significant differences in the overall survival between the two groups (p = 0.23). Advanced age does not have a significant impact on the outcomes of patients after resection of HCC.
Collapse
Affiliation(s)
- Masaharu Harada
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
Cho E, Cho HA, Jun CH, Kim HJ, Cho SB, Choi SK. A Review of Hepatocellular Carcinoma in Elderly Patients Focused on Management and Outcomes. In Vivo 2020; 33:1411-1420. [PMID: 31471386 DOI: 10.21873/invivo.11618] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 02/07/2023]
Abstract
Recent studies report a significant age-specific increase in hepatocellular carcinoma (HCC) development among persons over 75 years old. Therefore, there is an urgent need to determine the optimal treatment strategy in elderly patients with HCC. This systemic review examines the clinical characteristics, efficacy, and safety of first-line treatment modalities. The literature was searched regarding epidemiology and clinical outcomes in elderly patients (age ≥75 years) undergoing first-line treatment for HCC. Causative or comorbid conditions of HCC in elderly patients differed from those in younger patients. Radiofrequency ablation may be effective and safe in early stages. Surgical resection may also be feasible in the early stages for selected patients. Transarterial chemoembolization may be safe and effective for intermediate HCC, and sorafenib may be feasible in elderly patients with advanced HCC. Prospective randomized trials are needed to establish the treatment strategy for elderly patients with HCC.
Collapse
Affiliation(s)
- Eunae Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwanjgu, Republic of Korea
| | - Hyun A Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwanjgu, Republic of Korea
| | - Chung Hwan Jun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwanjgu, Republic of Korea
| | - Hee Joon Kim
- Department Surgery, Chonnam National University Medical School, Gwanjgu, Republic of Korea
| | - Sung Bum Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwanjgu, Republic of Korea
| | - Sung Kyu Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwanjgu, Republic of Korea
| |
Collapse
|
11
|
Chu KKW, Chok KSH. Is the treatment outcome of hepatocellular carcinoma inferior in elderly patients? World J Gastroenterol 2019; 25:3563-3571. [PMID: 31367157 PMCID: PMC6658391 DOI: 10.3748/wjg.v25.i27.3563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023] Open
Abstract
In view of the increasing life expectancy in different parts of the world, a larger proportion of elderly patients with hepatocellular carcinoma (HCC) requiring oncological treatment is expected. The clinicopathological characteristics of HCC in elderly patients and in younger patients are different. Elderly patients, in general, also have more comorbidities. Evaluation of the efficacy of different HCC treatment options in elderly patients is necessary to optimize treatment outcomes for them. Treatment modalities for HCC include hepatectomy, liver transplantation, radiofrequency ablation, transarterial chemoembolization, and molecular-targeted therapy with sorafenib. In this review, current evidence on the risks and outcomes of the different HCC treatments for elderly patients are discussed. According to data in the literature, elderly patients and younger patients benefited similarly from HCC treatments. More clinical data are needed for the determination of selecting criteria on elderly HCC patients to maximize their chance of getting the most appropriate and effective treatments. As such, further studies evaluating the outcomes of different HCC treatment modalities in elderly patients are warranted.
Collapse
Affiliation(s)
| | - Kenneth Siu Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
12
|
Seo JH, Kim DH, Cho E, Jun CH, Park SY, Cho SB, Park CH, Kim HS, Choi SK, Rew JS. Characteristics and Outcomes of Extreme Elderly Patients With Hepatocellular Carcinoma in South Korea. In Vivo 2019; 33:145-154. [PMID: 30587615 DOI: 10.21873/invivo.11451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing. But there is no proper management based on age stratification in elderly patients. Therefore, we evaluated the clinical characteristics and outcomes of elderly HCC patients more than 75 years old in South Korea. PATIENTS AND METHODS Five hundred and fifty elderly patients with HCC were enrolled and divided into the oldest-old (age ≥85 years), middle-old (age between 80 and 85 years), and young-old groups (age between 75 and 80 years). RESULTS Fifty-one, 153, and 346 patients were included in the oldest-old (mean age: 87 years), middle-old (mean age: 82 years), and young-old groups (mean age: 77 years), respectively. There was a significantly lower rate of alcohol-related and hepatitis B virus-related diseases in the oldest-old group than in the other groups, whereas there was no significant difference in other characteristics. With increasing age, conservative treatment was predominantly performed. Transarterial chemoembolization was the main modality of active treatment in all groups. In multivariate analysis, the performance score, model for end-stage liver disease score, modified Union for International Cancer Control staging, Barcelona Clinic Liver Cancer staging, presence of portal vein tumor thrombosis, ruptured HCC, and active treatment were risk factors of overall survival. CONCLUSION When the therapeutic approach is used in elderly patients with HCC, the patient's performance status, liver function, and stage of cancer should be considered, and its use should not be restricted to those of advanced age.
Collapse
Affiliation(s)
- Ji Ho Seo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Chung Hwan Jun
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Seon Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Chang Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Hyun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Jong Sun Rew
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| |
Collapse
|
13
|
Impact of Advanced Age on Survival in Patients Undergoing Resection of Hepatocellular Carcinoma. Ann Surg 2019; 269:692-699. [DOI: 10.1097/sla.0000000000002526] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
14
|
Validated nomogram for the prediction of disease-free survival after hepatectomy for hepatocellular carcinoma within the Milan criteria: individualizing a surveillance strategy. Surg Today 2019; 49:521-528. [PMID: 30637484 DOI: 10.1007/s00595-019-1764-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/24/2018] [Indexed: 12/22/2022]
|
15
|
Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, Uesaka K. The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching. Eur Surg Res 2018; 59:380-390. [PMID: 30554221 DOI: 10.1159/000494733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND With aging populations increasing in developed countries, the prevalence of elderly patients with hepatocellular carcinoma (HCC) is expected to rise. The aim of this study was to determine the short- and long-term outcomes of HCC surgery in elderly patients (≥75 years) using propensity score matching. METHODS The study group included 421 patients who underwent hepatectomy as their initial treatment with curative intent. The patients were divided into elderly (n = 111) and non-elderly (n = 310) groups. We applied propensity score matching - taking into consideration patient background, blood examination, and tumor factors - to minimize the effect of potential confounders. We then compared the results before and after the propensity matching. RESULTS Before propensity matching, the elderly group included significantly more patients with a high American Society of Anesthesiologists physical status (p < 0.001). In addition, they were taking antihypertensive drugs or an anticoagulant (both p < 0.001). The severe postoperative complications and the overall survival rates for these elderly patients were significantly poorer than for the non-elderly patients (p = 0.015 and p = 0.030, respectively). We then chose 70 patients from each group for whom the preoperative confounding factors were balanced and compared the two groups. The factors identified before matching (severe complications and overall survival rates) were no longer relevant, i.e. there were no significant differences between the two groups. CONCLUSION Hepatectomy for HCC in elderly patients is justified.
Collapse
Affiliation(s)
- Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan,
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| |
Collapse
|
16
|
Giovanardi F, Lai Q, Bertacco A, Vitale A. Resection for hepatocellular cancer: overpassing old barriers. Transl Gastroenterol Hepatol 2018; 3:64. [PMID: 30363682 DOI: 10.21037/tgh.2018.09.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/11/2018] [Indexed: 01/27/2023] Open
Abstract
Several recent studies have shown that the selection limits commonly used for patients with hepatocellular cancer (HCC) potentially requiring a liver resection (LR) are too restrictive. The present review aims at investigating the studies showing that LR is no longer a treatment suitable only for highly selected patients, but also for patients selectively presenting one-to-more negative factors. Several specific variables have been investigated, none of them showing to be an absolute contraindication for LR: age; single vs. multiple diseases; the dimension of the nodule; hyperbilirubinemia; clinically relevant portal hypertension; Child-Pugh status; macrovascular invasion. As a consequence, LR for the treatment of HCC-on-cirrhosis is a safe and effective procedure not only in "ideal cases", but also for selected patients presenting risk factors. The presence of only one of these factors does not represent an absolute contraindication for LR. On the opposite, the contemporaneous presence of risk factors should contraindicate the procedure. Further studies investigating the "borderline" cases are required, mainly looking at the possible decisive role of laparoscopy in this setting.
Collapse
Affiliation(s)
- Francesco Giovanardi
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Alessandra Bertacco
- Department of Surgery, Oncology and Gastroenterology, Padua University, Padua, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Padua University, Padua, Italy
| |
Collapse
|
17
|
Santambrogio R, Barabino M, Scifo G, Costa M, Giovenzana M, Opocher E. Effect of Age (over 75 Years) on Postoperative Complications and Survival in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2017; 21:657-665. [PMID: 28083840 DOI: 10.1007/s11605-016-3354-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/31/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thanks to technical advancement in surgery for hepatocellular carcinoma (HCC), hepatic resection (HR) for elderly HCC patients has become safer. However, elderly patients may have shorter long-term survival after surgery if compared with younger patients because of their expected life span. The aim of the present study was to evaluate clinical outcomes and safety after HR in HCC patients aged >75 years (older) compared with HCC patients aged <75 years (younger). METHOD One hundred sixty-eight patients who underwent HR for HCC from 1998 to 2015 in our Center were analyzed using a prospective database. Complications, disease-free survival rates, and cumulative survival rates were compared between the two groups. RESULTS During the immediate postoperative period, no differences were found about liver-related complications, hospital stay and 90-day mortality. However, older patients had more complications in class II or higher (Clavien classification) (p = 0.017). Although disease-free survival in both groups was similar (p = 0.099), overall survival was worse in the elderly group (p = 0.024). On multivariate analysis, only age ≥75 years was significantly related to overall survival. CONCLUSION If elderly patients with liver cirrhosis and HCC are appropriately selected and evaluated, they might have favorable prognoses after HR.
Collapse
Affiliation(s)
- Roberto Santambrogio
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy.
| | - Matteo Barabino
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Giovanna Scifo
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Mara Costa
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Marco Giovenzana
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Enrico Opocher
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| |
Collapse
|
18
|
Kinoshita A, Koike K, Nishino H. Clinical features and prognosis of elderly patients with hepatocellular carcinoma not indicated for surgical resection. Geriatr Gerontol Int 2016; 17:189-201. [PMID: 26847184 DOI: 10.1111/ggi.12747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 12/17/2022]
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide. The average life expectancy during the 20th century has increased in many parts of the world, and therefore the opportunities to examine elderly HCC patients have significantly increased worldwide. Many elderly patients develop HCC with intermediate to advanced stages of disease at the initial diagnosis, and have more comorbidities and compromised liver regeneration compared with younger patients. These circumstances show that elderly patients with HCC are poorer candidates for surgical resection or transplantation. The aim of the present review was to focus on the clinical features and prognosis of elderly HCC patients not indicated for surgical resection including multimodal treatment. Although the chronological age of 60 or 65 years as the definition of an elderly person is accepted in most countries, many studies in our review article define elderly as those aged 75 years or older. Geriatr Gerontol Int 2017; 17: 189-201.
Collapse
Affiliation(s)
- Akiyoshi Kinoshita
- Division of Gastroenterology and Hepatology, the Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuhiko Koike
- Division of Gastroenterology and Hepatology, the Jikei University Daisan Hospital, Tokyo, Japan
| | - Hirokazu Nishino
- Division of Gastroenterology and Hepatology, the Jikei University Daisan Hospital, Tokyo, Japan
| |
Collapse
|
19
|
Bauschke A, Altendorf-Hofmann A, Mothes H, Rauchfuß F, Settmacher U. Partial liver resection results in a significantly better long-term survival than locally ablative procedures even in elderly patients. J Cancer Res Clin Oncol 2016; 142:1099-108. [PMID: 26782669 DOI: 10.1007/s00432-016-2115-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/04/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The number of elderly patients with HCC will increase worldwide in the next years. Therefore, surgeons need to reassess clinical algorithms for the treatment of patients with HCC. We reevaluated a cohort of patients treated in the last 10 years at our hospital, with emphasis on long-term results and age. METHOD A prospectively recorded consecutive series of all patients treated in between January 1995 and December 2014 with curative intent either by partial liver resection or by ablative therapy was analysed. RESULTS At the time of diagnosis, 232 patients were younger than 70 years and 127 patients were aged 70 years and over. In the latter group, solitary tumours, absence of liver cirrhosis and resection therapy were more frequent compared to younger patients. Charlson index, AFP-negative tumours and CLIP score were equally distributed in both groups. Observed survival of older and younger patients was similar but after partial liver resection, younger patients had a better survival than elderly patients, whereas survival in patients treated with ablation was similar in both groups. In the univariate analysis, long-term survival of patients aged 70 years and over was influenced by treatment procedure, number of lesions, liver cirrhosis, Child's stage and CLIP score. In the multivariate analysis, only treatment procedure and CLIP score were identified as independent predictors of observed survival, and comorbidity was not. CONCLUSION In patients aged 70 years and over, long-term prognosis is independently influenced by CLIP score and treatment procedure and other findings have only minor influence on long-term survival.
Collapse
Affiliation(s)
- A Bauschke
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Street 104, 07740, Jena, Germany.
| | - A Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Street 104, 07740, Jena, Germany
| | - H Mothes
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Street 104, 07740, Jena, Germany
| | - F Rauchfuß
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Street 104, 07740, Jena, Germany
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Street 104, 07740, Jena, Germany
| |
Collapse
|
20
|
Hung AK, Guy J. Hepatocellular carcinoma in the elderly: Meta-analysis and systematic literature review. World J Gastroenterol 2015; 21:12197-12210. [PMID: 26576104 PMCID: PMC4641137 DOI: 10.3748/wjg.v21.i42.12197] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/03/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To conduct a meta-analysis to investigate the clinical outcomes of surgical resection and locoregional treatments for hepatocellular carcinoma (HCC) in elderly patients defined as aged 70 years or more.
METHODS: Literature documenting a comparison of clinical outcomes for elderly and non elderly patients with hepatocellular carcinoma was identified by searching PubMed, Ovid, Cochrane Library, and Web of Science databases, for those from inception to March 2015 with no limits. Dichotomous outcomes and standard meta-analysis techniques were used. Heterogeneity was tested by the Cochrane Q statistic. Pooled estimates were measured using the fixed or random effect model.
RESULTS: Twenty three studies were included with a total of 12482 patients. Of these patients, 6341 were treated with surgical resection, 3138 were treated with radiofrequency ablation (RFA), and 3003 were treated with transarterial chemoembolization (TACE). Of the patients who underwent surgical resection, the elderly had significantly more respiratory co-morbidities than the younger group, with both groups having a similar proportion of cardiovascular co-morbidities and diabetes. After 1 year, the elderly group had significantly increased survival rates after surgical resection compared to the younger group (OR = 0.762, 95%CI: 0.583-0.994, P = 0.045). However, the 3-year and 5-year survival outcomes with surgical resection between the two groups were similar (OR = 0.947, 95%CI: 0.777-1.154, P = 0.67 for the third year; and OR = 1.131, 95%CI: 0.895-1.430, P = 0.304 for the fifth year). Postoperative treatment complications were similar between the elderly and younger group. The elderly group and younger group had similar survival outcomes for the first and third year after RFA (OR = 1.5, 95%CI: 0.788-2.885, P = 0.217 and OR = 1.352, 95%CI: 0.940-1.944, P = 0.104). For the fifth year, the elderly group had significantly worse survival rates compared to the younger group after RFA (OR = 1.379, 95%CI: 1.079-1.763, P = 0.01). For patients who underwent TACE, the elderly group had significantly increased survival compared to the younger group for the first and third year (OR = 0.664, 95%CI: 0.548-0.805, P = 0.00 and OR = 0.795, 95%CI: 0.663-0.953, P = 0.013). At the fifth year, there were no significant differences in overall survival between the elderly group and younger group (OR = 1.256, 95%CI: 0.806-1.957, P = 0.313).
CONCLUSION: The optimal management strategy for elderly patients with HCC is dependent on patient and tumor characteristics. Compared to patients less than 70, elderly patients have similar three year survival after resection and ablation and an improved three year survival after TACE. At five years, elderly patients had a lower survival after ablation but similar survival with resection and TACE as compared to younger patients. Heterogeneity of patient populations and selection bias can explain some of these findings. Overall, elderly patients have similar success, if not better, with these treatments and should be considered for all treatments after assessment of their clinical status and cancer burden.
Collapse
|
21
|
Uncompromised treatment efficacy in elderly patients with hepatocellular carcinoma: a propensity score analysis: erratum. Medicine (Baltimore) 2015; 94:1. [PMID: 25802990 DOI: 10.1097/01.md.0000461199.07356.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
[In the article "Uncompromised Treatment Efficacy in Elderly Patients With Hepatocellular Carcinoma: A Propensity Score Analysis", which appeared in Volume 93, Issue 28 of Medicine, one of the authors' affiliations, National Yang-Ming University School of Medicine, Taipei, Taiwan, was omitted. The article has since been corrected online.].
Collapse
|