Zhang Qiu-Qiang, Wu Pan-Yi-Sha, ALBahde Mugahed, Zhang Lu-Fei, Zhou Zhu-Ha, Liu Hua, Li Yu-Feng, Wang Wei-Lin
Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China.
Front Oncol. 2020 Apr 16;10:479. doi: 10.3389/fonc.2020.00479. eCollection 2020.
The best treatment modalities for elderly patients with stage I-II HCC (hepatocellular carcinoma) remain controversial in an era of a shortage of liver donors. From the SEER database (Surveillance, Epidemiology, and End Results program), 2,371 elderly patients were sampled as Cohort 1. OS (Overall Survival) and CSS (Cancer-Specific Survival) were compared between the Non-surgery and Surgery groups. A stratification analysis in a CSS Cox model was also conducted among sub-groups, and propensity score matching was performed to generate Cohort 2 (746 pairs), reducing the influences of confounders. For Cohort 1, the median follow-up times of the Non-surgery and Surgery groups were 11 months (95% CI, confidence interval: 9.74-12.26) vs. 49 months (44.80-53.21) in OS, and 14 months (12.33-15.67) vs. 74 months (64.74-83.26) in CSS, respectively. In the stratification analysis, for the elderly patients (age >= 70 years), Larger Resection was associated with a higher HR (hazard ratio) than Segmental Resection: 0.30 (95% CI, confidence interval: 0.22-0.41) vs. 0.29 (0.21-0.38) in 70-74 year-olds; 0.26 (0.18-0.38) vs. 0.23 (0.16-0.32) in 75-79 year-olds; 0.32 (0.21-0.49) vs. 0.21 (0.13-0.32) in those 80+ years old. For Cohort 2, a similar result could be seen in the CSS Cox forest plot. The HRs of Larger Resection and Segmental Resection were 0.27 (0.21-0.33) and 0.25 (0.20-0.31), respectively. It is cautiously recommended that, when liver transplantation is not available, segmental or wedge liver resection is the better treatment choice for elderly patients with stage I-II HCC (AJCC edition 6), especially those over 70 years old, compared with other surgeries, based on the SEER data.
在肝脏供体短缺的时代，老年I-II期肝细胞癌（HCC）患者的最佳治疗方式仍存在争议。从监测、流行病学和最终结果（SEER）数据库中抽取了2371例老年患者作为队列1。比较了非手术组和手术组的总生存期（OS）和癌症特异性生存期（CSS）。还在亚组中进行了CSS Cox模型的分层分析，并进行倾向评分匹配以生成队列2（746对），减少混杂因素的影响。对于队列1，非手术组和手术组的OS中位随访时间分别为11个月（95%CI，置信区间：9.74-12.26）和49个月（44.80-53.21），CSS分别为14个月（12.33-15.67）和74个月（64.74-83.26）。在分层分析中，对于老年患者（年龄≥70岁），扩大切除术的风险比（HR）高于节段性切除术：70-74岁患者中分别为0.30（95%CI：0.22-0.41）和0.29（0.21-0.38）；75-79岁患者中分别为0.26（0.18-0.38）和0.23（0.16-0.32）；80岁及以上患者中分别为0.32（0.21-0.49）和0.21（0.13-0.32）。对于队列2，在CSS Cox森林图中也可以看到类似的结果。扩大切除术和节段性切除术的HR分别为0.27（0.21-0.33）和0.25（0.20-0.31）。根据SEER数据，谨慎建议，当无法进行肝移植时，对于I-II期HCC（AJCC第6版）老年患者，尤其是70岁以上患者，与其他手术相比，节段性或楔形肝切除术是更好的治疗选择。
