老年肝细胞癌患者手术切除后的特征与结局：系统评价与Meta分析
Characteristics and Outcomes of Elderly Hepatocellular Carcinoma Patients following Surgical Resection: Systematic Review and Meta-Analysis.
作者信息
Garcia Elizabeth M, Nerurkar Sanjna N, Tan Eunice X, Tan Shaun Y S, Peck Ern-Wei, Quek Sabrina X Z, Teh Readon, Teng Margaret, Tran Andrew, Yeo Ee Jin, Le Michael, Wong Connie, Cheung Ramsey, Huang Daniel Q
机构信息
Mountain View High School, Mountain View, California, USA.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
出版信息
Dig Dis. 2025;43(2):206-214. doi: 10.1159/000530101. Epub 2023 Mar 13.
BACKGROUND
Due to aging of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence-free survival (RFS), and complication rates in elderly HCC patients undergoing resection.
METHODS
We searched PubMed, Embase, and Cochrane databases from inception to November 10, 2020, for studies reporting outcomes in elderly (age ≥65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.
RESULTS
We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI: 72.89-76.02), 75.54% were male (95% CI: 72.53-78.32) and 66.73% had cirrhosis (95% CI: 43.93-83.96). The mean tumor size was 5.50 cm (95% CI: 4.71-6.29) and 16.01% had multiple tumors (95% CI: 10.74-23.19). The 1-year (86.02% vs. 86.66%, p = 0.84) and 5-year OS (51.60% vs. 53.78%) between non-elderly and elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% vs. 73.26%, p = 0.11) and 5-year RFS (31.57% vs. 30.25%, p = 0.67) between non-elderly and elderly patients. There was a higher rate of minor complications (21.95% vs. 13.71%, p = 0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p = 0.43).
CONCLUSION
These data show that OS, recurrence, and major complications after liver resection for HCC are comparable between elderly and non-elderly patients and may inform clinical management of HCC in this population.
BACKGROUND
Due to aging of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence-free survival (RFS), and complication rates in elderly HCC patients undergoing resection.
METHODS
We searched PubMed, Embase, and Cochrane databases from inception to November 10, 2020, for studies reporting outcomes in elderly (age ≥65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.
RESULTS
We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI: 72.89-76.02), 75.54% were male (95% CI: 72.53-78.32) and 66.73% had cirrhosis (95% CI: 43.93-83.96). The mean tumor size was 5.50 cm (95% CI: 4.71-6.29) and 16.01% had multiple tumors (95% CI: 10.74-23.19). The 1-year (86.02% vs. 86.66%, p = 0.84) and 5-year OS (51.60% vs. 53.78%) between non-elderly and elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% vs. 73.26%, p = 0.11) and 5-year RFS (31.57% vs. 30.25%, p = 0.67) between non-elderly and elderly patients. There was a higher rate of minor complications (21.95% vs. 13.71%, p = 0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p = 0.43).
CONCLUSION
These data show that OS, recurrence, and major complications after liver resection for HCC are comparable between elderly and non-elderly patients and may inform clinical management of HCC in this population.
背景
由于全球人口老龄化，肝细胞癌（HCC）在老年患者中越来越常见，但根治性肝切除术后的结果尚不清楚。我们采用荟萃分析方法，旨在评估接受肝切除的老年HCC患者的总生存期（OS）、无复发生存期（RFS）和并发症发生率。
方法
我们检索了从数据库建立至2020年11月10日的PubMed、Embase和Cochrane数据库，以查找报告接受根治性手术切除的老年（年龄≥65岁）HCC患者结局的研究。使用随机效应模型生成汇总估计值。
结果
我们筛选了8598篇文章，纳入了42项研究（7778例老年患者）。平均年龄为74.45岁（95%置信区间：72.89 - 76.02），75.54%为男性（95%置信区间：72.53 - 78.32），66.73%有肝硬化（95%置信区间：43.93 - 83.96）。平均肿瘤大小为5.50 cm（95%置信区间：4.71 - 6.29），16.01%有多个肿瘤（95%置信区间：10.74 - 23.19）。非老年患者和老年患者的1年总生存率（86.02%对86.66%，p = 0.84）和5年总生存率（51.60%对53.78%）相似。同样，非老年患者和老年患者的1年无复发生存率（67.32%对73.26%，p = 0.11）和5年无复发生存率（31.57%对30.25%，p = 0.67）也没有差异。与非老年患者相比，老年患者的轻微并发症发生率更高（21.95%对13.71%，p = 0.03），但严重并发症发生率没有差异（p = 0.43）。
结论
这些数据表明，老年和非老年患者肝癌肝切除术后的总生存期、复发情况和严重并发症相当，这可能为该人群肝癌的临床管理提供参考。
背景
由于全球人口老龄化，肝细胞癌（HCC）在老年患者中越来越常见，但根治性肝切除术后的结果尚不清楚。我们采用荟萃分析方法，旨在评估接受肝切除的老年HCC患者的总生存期（OS）、无复发生存期（RFS）和并发症发生率。
方法
我们检索了从数据库建立至202年11月10日的PubMed、Embase和Cochrane数据库，以查找报告接受根治性手术切除的老年（年龄≥65岁）HCC患者结局的研究。使用随机效应模型生成汇总估计值。
结果
我们筛选了8598篇文章，纳入了42项研究（7778例老年患者）。平均年龄为74.45岁（95%置信区间：72.89 - 76.02），75.54%为男性（95%置信区间：72.53 - 78.32），66.73%有肝硬化（95%置信区间：43.93 - 83.96）。平均肿瘤大小为5.50 cm（95%置信区间：4.71 - 6.29），16.01%有多个肿瘤（95%置信区间：10.74 - 23.19）。非老年患者和老年患者的1年总生存率（86.02%对86.66%，p = 0.84）和5年总生存率（51.60%对53.任8%）相似。同样，非老年患者和老年患者的1年无复发生存率（67.32%对73.26%，p = 0.11）和5年无复发生存率（31.57%对30.25%，p = 0.67）也没有差异。与非老年患者相比，老年患者的轻微并发症发生率更高（21.95%对13.71%，p = 0.03），但严重并发症发生率没有差异（p = 0.43）。
结论
这些数据表明，老年和非老年患者肝癌肝切除术后的总生存期、复发情况和严重并发症相当，这可能为该人群肝癌的临床管理提供参考。
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