Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Clin Gastroenterol. 2012 Jan;46(1):62-70. doi: 10.1097/MCG.0b013e31822b36cc.
To evaluate the impact of age on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA).
Whether age plays an important role in the outcomes of HCC after RFA remains controversial.
Two hundred fifty-eight consecutive treatment naive HCC patients who underwent RFA were enrolled. Patients aged ≤ 65 years (n = 100) were defined as the younger group and those aged > 65 years (n = 158) were the elderly group. Their clinicopathologic features and prognosis were compared.
Younger patients had a higher male-to-female ratio, higher prevalence of hepatitis B virus, and smaller tumor size than elder patients. After median follow-up of 28.5 ± 18.7 months, 45 patients died. The cumulative 5-year survival rates were 81.3% and 65.4% in younger and elder HCC patients, respectively (P = 0.008). Multivariate analysis disclosed that age > 65 years, serum albumin level ≤ 3.7 g/dL, prothrombin time international normalized ratio > 1.1, α-fetoprotein (AFP) > 20 ng/mL, and no antiviral therapy after RFA were independent risk factors associated with poor overall survival. Besides, there were 163 patients with tumor recurrence after RFA. Multivariate analysis showed that age > 65 years, platelet count ≤ 10/mm, AFP > 20 ng/mL, multinodularity, and tumor size > 2 cm were the independent risk factors predicting recurrence.
Both liver functional reserve (serum albumin level, prothrombin time international normalized ratio, platelet count, and antiviral therapy) and tumor factors (tumor size, number, and AFP level) were crucial in determining post-RFA prognosis in HCC patients. Moreover, younger HCC patients have better overall survival and lower recurrence rate after RFA compared with elder patients.
评估年龄对接受经皮射频消融（RFA）治疗的肝细胞癌（HCC）患者预后的影响。
年龄是否在 RFA 后 HCC 的结局中起重要作用仍存在争议。
共纳入 258 例接受 RFA 治疗的初治 HCC 患者。年龄≤65 岁的患者（n=100）定义为年轻组，年龄>65 岁的患者（n=158）为老年组。比较两组患者的临床病理特征和预后。
年轻患者的男女比例更高，乙型肝炎病毒感染率更高，肿瘤直径更小。中位随访 28.5±18.7 个月后，45 例患者死亡。年轻和老年 HCC 患者的 5 年累积生存率分别为 81.3%和 65.4%（P=0.008）。多因素分析显示，年龄>65 岁、血清白蛋白水平≤3.7g/dL、凝血酶原时间国际标准化比值>1.1、甲胎蛋白（AFP）>20ng/mL 和 RFA 后无抗病毒治疗是与总体生存不良相关的独立危险因素。此外，163 例患者在 RFA 后出现肿瘤复发。多因素分析显示，年龄>65 岁、血小板计数≤10/mm3、AFP>20ng/mL、多灶性和肿瘤直径>2cm 是预测复发的独立危险因素。
肝脏功能储备（血清白蛋白水平、凝血酶原时间国际标准化比值、血小板计数和抗病毒治疗）和肿瘤因素（肿瘤大小、数量和 AFP 水平）均对 HCC 患者 RFA 后预后具有重要意义。此外，与老年患者相比，年轻 HCC 患者 RFA 后总体生存更好，复发率更低。
