Masaki Kaibori1, Kengo Yoshii2, Isao Yokota3, Kiyoshi Hasegawa4, Fumio Nagashima5, Shoji Kubo6, Masanori Kon1, Namiki Izumi7, Masumi Kadoya8, Masatoshi Kudo9, Takashi Kumada10, Michiie Sakamoto11, Osamu Nakashima12, Yutaka Matsuyama13, Tadatoshi Takayama14, Norihiro Kokudo15. 1. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. 2. Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan. 4. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 5. Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan. 6. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 7. Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo, Japan. 8. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan. 9. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan. 10. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. 11. Department of Pathology, Keio University School of Medicine, Tokyo, Japan. 12. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan. 13. Department of Biostatics, School of Public Health University of Tokyo, Tokyo, Japan. 14. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. 15. National Center for Global Health and Medicine, Tokyo, Japan.
Abstract
OBJECTIVE: The impact of age on survival after hepatic resection for hepatocellular carcinoma (HCC) has not been thoroughly examined. We reviewed the data of a nationwide follow-up survey to determine the outcomes of hepatectomy for HCC in elderly patients. BACKGROUND: Management of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for liver surgery. METHODS: In all, 12,587 patients with HCC who underwent curative hepatic resection were included in this cohort study and classified according to age group [40-59 years (n = 2991), 60-74 years (n = 7576,), and ≥75 years (n = 2020)]. Clinicopathological features, long-term survival, and cumulative incidences of death after hepatic resection were compared among the groups. The cause-specific subdistribution hazard ratios for 3 types of death depending on age were also estimated. RESULTS: Preoperative liver function tests showed that the prothrombin activity and platelet count were higher in the ≥75-year age group than in the other age groups. The overall survival was significantly lower in the elderly than younger patients. However, recurrence-free survival was almost identical among the 3 groups. The cumulative incidence of HCC-related or liver-related death was almost identical among the 3 groups; however, the cumulative incidence of other causes of death was significantly different. The 60-year subdistribution hazard ratio for other causes of death increased remarkably with increasing age. CONCLUSIONS: Elderly patients in this nationwide survey had significantly worse overall survival after hepatectomy than middle-aged and young patients. The cumulative incidence of other causes of death in elderly patients was significantly different from that of HCC-related or liver-related death among the 3 groups.
OBJECTIVE: The impact of age on survival after hepatic resection for hepatocellular carcinoma (HCC) has not been thoroughly examined. We reviewed the data of a nationwide follow-up survey to determine the outcomes of hepatectomy for HCC in elderly patients. BACKGROUND: Management of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for liver surgery. METHODS: In all, 12,587 patients with HCC who underwent curative hepatic resection were included in this cohort study and classified according to age group [40-59 years (n = 2991), 60-74 years (n = 7576,), and ≥75 years (n = 2020)]. Clinicopathological features, long-term survival, and cumulative incidences of death after hepatic resection were compared among the groups. The cause-specific subdistribution hazard ratios for 3 types of death depending on age were also estimated. RESULTS: Preoperative liver function tests showed that the prothrombin activity and platelet count were higher in the ≥75-year age group than in the other age groups. The overall survival was significantly lower in the elderly than younger patients. However, recurrence-free survival was almost identical among the 3 groups. The cumulative incidence of HCC-related or liver-related death was almost identical among the 3 groups; however, the cumulative incidence of other causes of death was significantly different. The 60-year subdistribution hazard ratio for other causes of death increased remarkably with increasing age. CONCLUSIONS: Elderly patients in this nationwide survey had significantly worse overall survival after hepatectomy than middle-aged and young patients. The cumulative incidence of other causes of death in elderly patients was significantly different from that of HCC-related or liver-related death among the 3 groups.
Authors: In Sik Shin; Deok Gie Kim; Sung Whan Cha; Seong Hee Kang; Sung Hoon Kim; Moon Young Kim; Soon Koo Baik Journal: Ann Surg Treat Res Date: 2020-07-31 Impact factor: 1.859