Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Department of General Surgery, Liuyang People's Hospital, Hunan, China.
HPB (Oxford). 2020 Sep;22(9):1314-1323. doi: 10.1016/j.hpb.2019.12.006. Epub 2020 Jan 21.
Aging of the population and prolonged life expectancy have significantly increased the number of elderly patients undergoing hepatectomy for hepatocellular carcinoma (HCC). However, potential benefits, especially long-term oncologic outcomes of hepatectomy for elderly patients with HCC remain unclear.
Patients treated with curative-intent hepatectomy for HCC in 8 Chinese hospitals were enrolled. Patients were divided into the elderly (≥70 years old) and younger (<70 years old) groups. Overall survival (OS), cancer-specific survival (CSS), and time-to-recurrence (TTR) were compared. Risk factors of CSS and TTR were evaluated by univariable and multivariable competing-risk regression analyses.
Of 2134 patients, 259 (12.1%) and 1875 (87.9%) were elderly and younger aged, respectively. Postoperative 30-day and 90-day mortality was comparable among elderly and younger patients. Compared with younger patients, the elderly had a worse 5-year OS (49.4% vs. 55.3%, P = 0.032), yet a better 5-year CCS (74.5% vs. 61.0%, P = 0.005) and a lower 5-year TTR (33.7% vs. 44.9%, P < 0.001), respectively. Multivariable analyses identified that elder age was independently associated with more favorable CSS (HR 0.74, 95%CI 0.58-0.90, P = 0.011) and TTR (0.69, 0.53-0.88, P < 0.001) but was not associated with OS (P = 0.136).
Age by itself is not a contraindication to surgery, and selected elderly patients with HCC can benefit from hepatectomy. Compared with younger patients, elderly patients have noninferior oncologic outcomes following hepatectomy for HCC.
人口老龄化和预期寿命的延长显著增加了因肝细胞癌（HCC）而行肝切除术的老年患者数量。然而，老年 HCC 患者行肝切除术的潜在益处，特别是长期肿瘤学结局仍不明确。
本研究纳入了 8 家中国医院接受根治性肝切除术治疗 HCC 的患者。患者分为老年（≥70 岁）和年轻（<70 岁）两组。比较总生存期（OS）、癌症特异性生存期（CSS）和无复发生存时间（TTR）。采用单变量和多变量竞争风险回归分析评估 CSS 和 TTR 的危险因素。
在 2134 例患者中，259 例（12.1%）和 1875 例（87.9%）为老年和年轻患者。老年和年轻患者术后 30 天和 90 天死亡率相当。与年轻患者相比，老年患者的 5 年 OS 较差（49.4% vs. 55.3%，P=0.032），但 5 年 CSS 更好（74.5% vs. 61.0%，P=0.005）和 5 年 TTR 更低（33.7% vs. 44.9%，P<0.001）。多变量分析确定，年龄较大与 CSS（HR 0.74，95%CI 0.58-0.90，P=0.011）和 TTR（0.69，0.53-0.88，P<0.001）的改善独立相关，但与 OS 无关（P=0.136）。
年龄本身并不是手术的禁忌症，选择合适的老年 HCC 患者可以从肝切除术中获益。与年轻患者相比，老年患者行 HCC 肝切除术后的肿瘤学结局非劣效。
