Masaki Kaibori1, Kengo Yoshii2, Kiyoshi Hasegawa3, Asao Ogawa4, Shoji Kubo5, Ryosuke Tateishi6, 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. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 4. Department of Psycho-oncology, National Cancer Center East Hospital, Kashiwa, Japan. 5. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 6. Department of Gastroenterology, Training Program for Oncology Professionals Graduate School of Medicine, University of Tokyo, Tokyo, 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 Biostatistics, 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: We reviewed nationwide follow-up data to determine outcomes of different treatments for early-stage hepatocellular carcinoma (HCC) in elderly patients. SUMMARY BACKGROUND DATA: Outcomes of early-stage HCC treatments in elderly patients have not been prospectively compared. METHODS: We included 6490 HCC patients, aged ≥75 years at treatment, who underwent curative hepatic resection (HR, n = 2020), radiofrequency ablation (RFA, n = 1888), microwave ablation (MWA, n = 193), or transcatheter arterial chemoembolization (TACE, n = 2389), and compared their characteristics and survival. We used matching propensity score analysis (PSA) between the HR and RFA subgroups with tumors ≤3 cm to overcome baseline bias. RESULTS: The HR group had significantly longer recurrence-free survival (RFS) than the RFA, MWA, and TACE groups [RFA vs HR-hazard ratio: 1.22, 95% confidence interval (CI): 1.09-1.37, P < 0.001; MWA vs HR-hazard ratio: 1.51, 95% CI: 1.22-1.88, P < 0.001; TACE vs HR-hazard ratio: 2.70, 95% CI: 2.44-2.99, P < 0.001). HR and RFA patients had significantly longer overall survival (OS) than the TACE group (RFA vs HR-hazard ratio: 1.01, 95% CI: 0.87-1.17, P = 0.919, TACE vs HR-hazard ratio: 2.11, 95% CI: 1.86-2.40, P < 0.001). PSA successfully matched HR and RFA patients from with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics; and showed significantly longer RFS (hazard ratio: 1.64, 95% CI: 1.29-2.10, P < 0.001) and OS (hazard ratio: 1.57, 95% CI: 1.12-2.20, P = 0.009) for HR than for RFA (including subgroup analyses). In Cox proportional hazard analysis, HR offered better prognosis than RFA. CONCLUSIONS: HR decreases recurrence risk and improves OS in patients aged ≥75 years with primary HCC tumors ≤3.0 cm.
OBJECTIVE: We reviewed nationwide follow-up data to determine outcomes of different treatments for early-stage hepatocellular carcinoma (HCC) in elderly patients. SUMMARY BACKGROUND DATA: Outcomes of early-stage HCC treatments in elderly patients have not been prospectively compared. METHODS: We included 6490 HCC patients, aged ≥75 years at treatment, who underwent curative hepatic resection (HR, n = 2020), radiofrequency ablation (RFA, n = 1888), microwave ablation (MWA, n = 193), or transcatheter arterial chemoembolization (TACE, n = 2389), and compared their characteristics and survival. We used matching propensity score analysis (PSA) between the HR and RFA subgroups with tumors ≤3 cm to overcome baseline bias. RESULTS: The HR group had significantly longer recurrence-free survival (RFS) than the RFA, MWA, and TACE groups [RFA vs HR-hazard ratio: 1.22, 95% confidence interval (CI): 1.09-1.37, P < 0.001; MWA vs HR-hazard ratio: 1.51, 95% CI: 1.22-1.88, P < 0.001; TACE vs HR-hazard ratio: 2.70, 95% CI: 2.44-2.99, P < 0.001). HR and RFA patients had significantly longer overall survival (OS) than the TACE group (RFA vs HR-hazard ratio: 1.01, 95% CI: 0.87-1.17, P = 0.919, TACE vs HR-hazard ratio: 2.11, 95% CI: 1.86-2.40, P < 0.001). PSA successfully matched HR and RFA patients from with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics; and showed significantly longer RFS (hazard ratio: 1.64, 95% CI: 1.29-2.10, P < 0.001) and OS (hazard ratio: 1.57, 95% CI: 1.12-2.20, P = 0.009) for HR than for RFA (including subgroup analyses). In Cox proportional hazard analysis, HR offered better prognosis than RFA. CONCLUSIONS: HR decreases recurrence risk and improves OS in patients aged ≥75 years with primary HCC tumors ≤3.0 cm.
Authors: Xi Xu; Xingyu Pu; Li Jiang; Yang Huang; Lunan Yan; Jiayin Yang; Tianfu Wen; Bo Li; Hong Wu; Wentao Wang Journal: J Cancer Res Clin Oncol Date: 2020-08-27 Impact factor: 4.553
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Authors: Melchiorre Cervello; Maria R Emma; Giuseppa Augello; Antonella Cusimano; Lydia Giannitrapani; Maurizio Soresi; Shaw M Akula; Stephen L Abrams; Linda S Steelman; Alessandro Gulino; Beatrice Belmonte; Giuseppe Montalto; James A McCubrey Journal: Aging (Albany NY) Date: 2020-02-04 Impact factor: 5.682