Lee Han Ah, Lee Sangheun, Lee Hae Lim, Song Jeong Eun, Lee Dong Hyeon, Han Sojung, Shim Ju Hyun, Kim Bo Hyun, Choi Jong Young, Rhim Hyunchul, Kim Do Young
Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
J Liver Cancer. 2023 Sep;23(2):362-376. doi: 10.17998/jlc.2023.08.03. Epub 2023 Sep 14.
BACKGROUND/AIM: Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.
背景/目的：尽管随着时间推移，老年肝细胞癌（HCC）患者的比例不断增加，但该人群的治疗效果尚未明确。
分析了从韩国原发性肝癌登记处收集的数据，该登记处是2008年至2017年期间韩国新诊断为HCC患者的代表性队列。比较了老年和非老年HCC患者根据肿瘤分期和治疗方式的总生存期（OS）。
在15186例研究患者中，5829例（38.4%）为老年人。与非老年患者相比，未接受任何HCC治疗的老年患者比例更高（25.2%对16.7%）。然而，接受治疗的老年患者的OS明显优于未接受治疗的患者（中位数分别为38.6个月和22.3个月；P<0.001）。在早期HCC中，与非老年患者相比，老年患者手术的OS显著较低（中位数分别为97.4个月和138.0个月；P<0.001），然而，在治疗逆概率加权（IPTW）分析后，局部消融（中位数分别为82.2个月和105.5个月）和经动脉治疗（中位数分别为42.6个月和56.9个月）在两组中提供了相当的OS（所有P>0.05）。IPTW后，在中期HCC中，手术（中位数分别为66.0个月和90.3个月）和经动脉治疗（中位数分别为36.5个月和37.2个月），在晚期HCC中，经动脉治疗（中位数分别为25.3个月和26.3个月）和全身治疗（中位数分别为25.3个月和26.3个月）在老年和非老年HCC患者中产生了相当的OS（所有P>0.05）。
针对个体患者的个性化治疗可以将老年HCC患者的预后提高到与非老年患者相当的水平。
