Zhang Huixin, Xu Muoyan, Shao Jiashen, Kong Huifang, Gao Xudong, Zhang Wei, Chang Xiujuan, Yang Bin, Chen Yan, Dong Zheng, Huang Jiagan, Zeng Zhen, Yang Yongping
Department of Liver Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
Healthcare Office of Chinese PLA General Hospital, Beijing, China.
Front Oncol. 2023 Jan 20;13:1072054. doi: 10.3389/fonc.2023.1072054. eCollection 2023.
Hepatocellular carcinoma (HCC) is the major cause of malignancy-related deaths worldwide, and its incidence is likely to increase in the future as life expectancy increases. Therefore, the management of elderly patients with HCC has become a global issue. Aim of this study was to assess whether elderly patients with small HCC could obtain survival benefit from cryoablation (CRYO) in a real-world.
From July 2007 to June 2013, 185 patients with small HCC who underwent curative-intent percutaneous CRYO. All patients were divided into three groups according to age distribution. Overall survival (OS) and tumor-free survival (TFS) were compared between among of groups before and after the 1:1 propensity score matching, respectively. Univariate and multivariate Cox analyses were performed to determine the potential relationships between variables and prognostic outcomes.
One hundred and eighty-five patients (144 men, 41 women) received CRYO for small HCC, including 59 patients with age <50 years, 105 patients with age between 50 and 65 years, and 21 patients with age >65 years. The three age groups showed significant differences in the terms of underlying chronic liver disease and the number of patients with minor postoperative complications. After propensity score matching, the younger and elderly groups showed significant differences in mean OS (P=0.008) and tumor progression (P=0.050). However, no significant differences were shown in mean progression-free survival (PFS) (P=0.303). The Cox multivariate analysis showed that the Child-Pugh grade (HR=3.1, P<0.001), albumin (HR=0.85, P=0.004) and total of bilirubin (HR=1, P=0.024) were the independent prognostic factor for mean OS.
Our propensity-score-matched study suggested that elderly patients with small HCC can achieve acceptable prognostic outcomes with PFS similar to those of younger patients with small HCC after treatment with CRYO, while Child-Pugh grade, bilirubin and serum albumin levels were associated with the prognosis of small HCCs.
肝细胞癌（HCC）是全球恶性肿瘤相关死亡的主要原因，随着预期寿命的增加，其发病率未来可能会上升。因此，老年HCC患者的管理已成为一个全球性问题。本研究的目的是评估在现实世界中，老年小肝癌患者接受冷冻消融（CRYO）是否能获得生存益处。
2007年7月至2013年6月，185例接受根治性经皮冷冻消融的小肝癌患者。所有患者根据年龄分布分为三组。在1:1倾向评分匹配前后，分别比较各组之间的总生存期（OS）和无瘤生存期（TFS）。进行单因素和多因素Cox分析以确定变量与预后结果之间的潜在关系。
185例患者（144例男性，41例女性）接受了小肝癌冷冻消融治疗，其中年龄<50岁的患者59例，年龄在50至65岁之间的患者105例，年龄>65岁的患者21例。这三个年龄组在潜在慢性肝病和术后轻微并发症患者数量方面存在显著差异。倾向评分匹配后，年轻组和老年组在平均OS（P=0.008）和肿瘤进展（P=0.050）方面存在显著差异。然而，平均无进展生存期（PFS）无显著差异（P=0.303）。Cox多因素分析显示，Child-Pugh分级（HR=3.1，P<0.001）、白蛋白（HR=0.85，P=0.004）和总胆红素（HR=1，P=0.024）是平均OS的独立预后因素。
我们的倾向评分匹配研究表明，老年小肝癌患者在接受冷冻消融治疗后，可获得与年轻小肝癌患者相似的可接受预后结果，而Child-Pugh分级、胆红素和血清白蛋白水平与小肝癌的预后相关。
