Major Hepatectomy in Elderly Patients with Large Hepatocellular Carcinoma: A Multicenter Retrospective Observational Study
| Autor: | Yong-Kang Diao, Cheng-Wu Zhang, Wan Yee Lau, Ying-Jian Liang, Zheng-Liang Chen, Han Wu, Meng-Chao Wu, Yongyi Zeng, Yao-Ming Zhang, Hong Wang, Wei-Min Gu, Tian Yang, Feng Shen, Ting-Hao Chen, Lei Liang, Jie Li, Ya-Hao Zhou, Wan-Guang Zhang, Chao Li |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty business.industry medicine.medical_treatment Retrospective cohort study medicine.disease Gastroenterology 03 medical and health sciences 030104 developmental biology 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Internal medicine Hepatocellular carcinoma Cohort Life expectancy Overall survival medicine Multiple tumors Hepatectomy business Major hepatectomy |
| Zdroj: | Cancer Management and Research. 12:5607-5618 |
| ISSN: | 1179-1322 |
| DOI: | 10.2147/cmar.s258150 |
| Popis: | Background With an increase in life expectancy and improvement of surgical safety, more elderly patients with hepatocellular carcinoma (HCC), even with large tumors, are now considered for hepatectomy. This study aimed to clarify the impact of age on short- and long-term outcomes after major hepatectomy (≥3 segments) for large HCC (≥5 cm). Patients and methods Using a multicenter database, patients who underwent curative-intent major hepatectomy for large HCC between 2006 and 2016 were identified. Postoperative morbidity and mortality, overall survival (OS) and recurrence-free survival (RFS) were compared between the elderly (≥65 years) and younger ( Results Of 830 patients, 92 (11.1%) and 738 (88.9%) were elderly and younger patients, respectively. There were no significant differences in postoperative 30-day mortality and morbidity between the two groups (5.4% vs 2.6% and 43.5% vs 38.3%, both P>0.05). The 5-year OS and RFS rates in elderly patients were also comparable to younger patients (35.0% vs 33.2% and 20.0% vs 20.8%, both P>0.05). In the entire cohort, multivariable Cox-regression analyses identified that old age was not independently associated with OS and RFS. However, in the elderly cohort, preoperative alpha-fetoprotein level >400 μg/L, multiple tumors, macrovascular invasion and microvascular invasion were independently associated with decreased OS and RFS. Conclusion Carefully selected elderly patients benefited from major hepatectomy for large HCC as much as younger patients, and their long-term prognosis was determined by preoperative alpha-fetoprotein level, tumor number and presence of macro- or micro-vascular invasion. |
| Databáze: | OpenAIRE |
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