Department of Internal Medicine, Aiseikai Yamashina Hospital, Kyoto 602-8566, Japan.
World J Gastroenterol. 2012 Apr 28;18(16):1926-32. doi: 10.3748/wjg.v18.i16.1926.
To identify the factors associated with overall survival of elderly patients with hepatocellular carcinoma (HCC).
A total of 286 patients with HCC (male/female: 178/108, age: 46-100 years), who were diagnosed and treated by appropriate therapeutic procedures between January 2000 and December 2010, were enrolled in this study. Patients were stratified into two groups on the basis of age: Elderly (≥ 75 years old) and non-elderly (< 75 years old). Baseline clinical characteristics as well as cumulative survival rates were then compared between the two groups. Univariate and multivariate analyses were used to identify the factors associated with prolonged overall survival of patients in each group. Cumulative survival rates in the two groups were calculated separately for each modified Japan Integrated Stage score (mJIS score) category by the Kaplan-Meier method. In addition, we compared the cumulative survival rates of elderly and non-elderly patients with good hepatic reserve capacity (≤ 2 points as per mJIS).
In the elderly group, the proportion of female patients, patients with absence of hepatitis B or hepatitis C viral infection, and patients with coexisting extrahepatic comorbid illness was higher (56.8% vs 31.1%, P < 0.001; 27.0% vs 16.0%, P = 0.038; 33.8% vs 22.2%, P = 0.047; respectively) than that in the non-elderly group. In the non-elderly group, the proportion of hepatitis B virus (HBV)-infected patients was higher than that in the elderly group (9.4% vs 0%, P = 0.006). The cumulative survival rates in the elderly group were 53.7% at 3 years and 32.9% at 5 years, which were equivalent to those in the non-elderly group (55.9% and 39.4%, respectively), as shown by a log-rank test (P = 0.601). In multivariate analysis, prolonged survival was significantly associated with the extent of liver damage and stage (P < 0.001 and P < 0.001, respectively), but was not associated with patient age. However, on individual evaluation of factors in both groups, stage was significantly (P < 0.001) associated with prolonged survival. Regarding mJIS scores of ≤ 2, the rate of female patients with this score was higher in the elderly group when compared to that in the non-elderly group (P = 0.012) and patients ≥ 80 years of age tended to demonstrate shortened survival.
Survival of elderly HCC patients was associated with liver damage and stage, but not age, except for patients ≥ 80 years with mJIS score ≤ 2.
确定与老年肝细胞癌（HCC）患者总生存相关的因素。
本研究共纳入 286 名 HCC 患者（男/女：178/108，年龄：46-100 岁），他们于 2000 年 1 月至 2010 年 12 月期间接受了适当的治疗程序的诊断和治疗。根据年龄将患者分为两组：老年（≥75 岁）和非老年（＜75 岁）。然后比较两组之间的基线临床特征和累积生存率。使用单因素和多因素分析来确定与每组患者总生存时间延长相关的因素。使用 Kaplan-Meier 法分别为两组的每个改良日本综合分期评分（mJIS 评分）类别计算累积生存率。此外，我们比较了具有良好肝储备能力（mJIS 评分≤2 分）的老年和非老年患者的累积生存率。
在老年组中，女性患者、无乙型肝炎或丙型肝炎病毒感染的患者和同时存在肝外合并症的患者的比例较高（56.8%比 31.1%，P＜0.001；27.0%比 16.0%，P=0.038；33.8%比 22.2%，P=0.047）。而非老年组中，乙型肝炎病毒（HBV）感染患者的比例高于老年组（9.4%比 0%，P=0.006）。老年组的 3 年累积生存率为 53.7%，5 年累积生存率为 32.9%，与非老年组相当（55.9%和 39.4%），对数秩检验（P=0.601）显示差异无统计学意义。多因素分析显示，延长生存与肝损伤程度和分期显著相关（P＜0.001 和 P＜0.001），但与患者年龄无关。然而，在对两组的各个因素进行评估时，分期与延长生存显著相关（P＜0.001）。关于 mJIS 评分≤2，老年组女性患者的比例高于非老年组（P=0.012），且≥80 岁的患者生存时间往往更短。
除了 mJIS 评分≤2 的≥80 岁的患者外，老年 HCC 患者的生存与肝损伤和分期相关，而与年龄无关。
