Xie Qingqing, Yang Yongwen, Qu Bin, Xiao Ping, Tang Faqing, Shen Haoming
Department of Clinical Laboratory, Third Affiliated Hospital of Guangxi University of Chinese Medicine, Liuzhou, China.
Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China.
Front Oncol. 2022 Aug 25;12:903231. doi: 10.3389/fonc.2022.903231. eCollection 2022.
The treatment for hepatocellular carcinoma (HCC) remains controversial and limited in elderly patients. Therefore, we aimed to explore treatment choices for the elderly patients (≥ 65years) following surgical resection (SR) versus radiofrequency ablation (RFA) with HCC (single lesion less than 5 cm).
We used SEER database to identify HCC patients who received treatment of SR/RFA. Kaplan-Meier method and Cox proportional hazards regression method were used to determine the prognostic factors associated with overall survival (OS) and disease-specific survival (DSS). In addition, RFA group and SR group patients were matched with 1:1 propensity score matching (PSM) for diagnosis age, sex, race, marital, American Joint Committee on Cancer (AJCC), grade, radiotherapy, and chemotherapy to decrease the possibility of selection bias. Conditional disease-specific survival (CS) was estimated using the life-table method.
A total of 794 patients who underwent SR and 811 patients who underwent RFA were confirmed from the SEER database. Surgery type was an independent risk factor for HCC. Survival analysis indicated that SR, races, AJCC I, no chemotherapy treatment, and grade I were cumulative risk factors that can significantly improve median survival for HCC ( < 0.05). After PSM analysis, only surgery type was significantly improved median survival of HCC patients (SR vs. RFA, HR: 0.644, 95% CI: 0.482-0.86; < 0.001). For RFA group, the 2-, 3-, and 5-year CS rates were approximately 71%, 65%, and 62%, respectively, and corresponding to 82%, 80%, and 78% in the SR group.
SR treatment can provide survival benefits for elderly patients of <5 cm single lesion HCC.
肝细胞癌（HCC）的治疗在老年患者中仍存在争议且受限。因此，我们旨在探讨老年患者（≥65岁）手术切除（SR）与射频消融（RFA）治疗单病灶小于5 cm的HCC后的治疗选择。
我们使用监测、流行病学与最终结果（SEER）数据库来识别接受SR/RFA治疗的HCC患者。采用Kaplan-Meier法和Cox比例风险回归法确定与总生存期（OS）和疾病特异性生存期（DSS）相关的预后因素。此外，对RFA组和SR组患者按1:1倾向评分匹配（PSM）进行诊断年龄、性别、种族、婚姻状况、美国癌症联合委员会（AJCC）分期、分级、放疗和化疗匹配，以降低选择偏倚的可能性。采用寿命表法估计条件疾病特异性生存期（CS）。
从SEER数据库中确认了794例行SR的患者和811例行RFA的患者。手术类型是HCC的独立危险因素。生存分析表明，SR、种族、AJCC I期、未接受化疗治疗和I级是可显著提高HCC患者中位生存期的累积危险因素（P<0.05）。PSM分析后，仅手术类型可显著提高HCC患者的中位生存期（SR与RFA相比，HR：0.644，95%CI：0.482-0.86；P<0.001）。对于RFA组，2年、3年和5年的CS率分别约为71%、65%和62%，SR组相应为82%、80%和78%。
SR治疗可为单病灶小于5 cm的老年HCC患者提供生存获益。
