Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
Cancer Causes Control. 2021 Apr;32(4):317-325. doi: 10.1007/s10552-020-01386-x. Epub 2021 Jan 4.
Most patients with hepatocellular carcinoma (HCC) are ≥ 65 years old at diagnosis and ~ 20% present with disease amenable to curative intent surgical therapy. The aim of this study was to examine whether treatment, the demographic variables, and clinical factors could predict 5-year survival among HCC patients.
We included patients, 66 years or older, diagnosed with a first primary HCC from 1994 through 2007 in the SEER-Medicare database, and followed up until death or 31 December 2012. Curative intent treatment was defined as liver transplantation, surgery resection, or ablation. We estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with 5-year survival using logistic regression.
We identified 10,826 patients with HCC with mean age 75.3 (standard deviation, 6.4) years. Most were male (62.2%) and non-Hispanic white (59.7%). Overall, only 8.1% of patients were alive 5 years post-HCC diagnosis date. Among all patients that survived ≥ 5 years, 69.8% received potentially curative treatment. Conversely, patients who received potentially curative treatment represented only 15.7% of patients who survived < 5 years. Curative intent treatment was the strongest predictor for surviving ≥ 5 years (vs. none/palliative treatment; adjusted OR 8.12, 95% CI 6.90-9.64). While stage at diagnosis and comorbidities were also independently associated with ≥ 5-year survival in HCC patients, these factors did not improve discrimination between short- and long-term survivors.
Curative intent treatment was the strongest predictor for survival ≥ 5 years among HCC patients. Given the limited availability of liver transplant and limited eligibility for surgical resection, finding curative intent HCC therapies remain critically important.
大多数肝细胞癌 (HCC) 患者在诊断时年龄≥65 岁，约 20%的患者存在可接受根治性手术治疗的疾病。本研究旨在探讨治疗方法、人口统计学变量和临床因素是否可以预测 HCC 患者的 5 年生存率。
我们纳入了 1994 年至 2007 年期间在 SEER-Medicare 数据库中诊断为首次原发性 HCC 的年龄为 66 岁或以上的患者，并随访至死亡或 2012 年 12 月 31 日。根治性治疗定义为肝移植、手术切除或消融。我们使用逻辑回归估计 5 年生存率与治疗方法、人口统计学变量和临床因素之间的关联的优势比（OR）和 95%置信区间（CI）。
我们共纳入了 10826 例 HCC 患者，平均年龄为 75.3（标准差为 6.4）岁。大多数患者为男性（62.2%）和非西班牙裔白人（59.7%）。总体而言，只有 8.1%的患者在 HCC 诊断日期后 5 年仍存活。在所有存活≥5 年的患者中，69.8%接受了潜在的根治性治疗。相反，在存活<5 年的患者中，仅 15.7%接受了潜在的根治性治疗。根治性治疗是存活≥5 年的最强预测因素（与无治疗/姑息治疗相比；调整后的 OR 8.12，95%CI 6.90-9.64）。尽管在 HCC 患者中，诊断时的分期和合并症也是与存活≥5 年相关的独立因素，但这些因素并不能改善对短期和长期生存者的区分。
根治性治疗是 HCC 患者存活≥5 年的最强预测因素。鉴于肝移植的可用性有限且手术切除的资格有限，寻找根治性 HCC 治疗方法仍然至关重要。
