Treatment Optimization for Hepatocellular Carcinoma in Elderly Patients in a Japanese Nationwide Cohort

Liver Cancer Study Group of Japan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVE: We reviewed nationwide follow-up data to determine outcomes of different treatments for early-stage hepatocellular carcinoma (HCC) in elderly patients. SUMMARY BACKGROUND DATA: Outcomes of early-stage HCC treatments in elderly patients have not been prospectively compared. METHODS: We included 6490 HCC patients, aged ≥75 years at treatment, who underwent curative hepatic resection (HR, n = 2020), radiofrequency ablation (RFA, n = 1888), microwave ablation (MWA, n = 193), or transcatheter arterial chemoembolization (TACE, n = 2389), and compared their characteristics and survival. We used matching propensity score analysis (PSA) between the HR and RFA subgroups with tumors ≤3 cm to overcome baseline bias. RESULTS: The HR group had significantly longer recurrence-free survival (RFS) than the RFA, MWA, and TACE groups [RFA vs HR-hazard ratio: 1.22, 95% confidence interval (CI): 1.09-1.37, P < 0.001; MWA vs HR-hazard ratio: 1.51, 95% CI: 1.22-1.88, P < 0.001; TACE vs HR-hazard ratio: 2.70, 95% CI: 2.44-2.99, P < 0.001). HR and RFA patients had significantly longer overall survival (OS) than the TACE group (RFA vs HR-hazard ratio: 1.01, 95% CI: 0.87-1.17, P = 0.919, TACE vs HR-hazard ratio: 2.11, 95% CI: 1.86-2.40, P < 0.001). PSA successfully matched HR and RFA patients from with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics; and showed significantly longer RFS (hazard ratio: 1.64, 95% CI: 1.29-2.10, P < 0.001) and OS (hazard ratio: 1.57, 95% CI: 1.12-2.20, P = 0.009) for HR than for RFA (including subgroup analyses). In Cox proportional hazard analysis, HR offered better prognosis than RFA. CONCLUSIONS: HR decreases recurrence risk and improves OS in patients aged ≥75 years with primary HCC tumors ≤3.0 cm.

Original languageEnglish
Pages (from-to)121-130
Number of pages10
JournalAnnals of surgery
Volume270
Issue number1
DOIs
Publication statusPublished - 2019 Jul 1

Fingerprint

Hepatocellular Carcinoma
Confidence Intervals
Survival
Propensity Score
Recurrence
Therapeutics
Neoplasms
Liver
Microwaves

ASJC Scopus subject areas

  • Surgery

Cite this

Treatment Optimization for Hepatocellular Carcinoma in Elderly Patients in a Japanese Nationwide Cohort. / Liver Cancer Study Group of Japan.

In: Annals of surgery, Vol. 270, No. 1, 01.07.2019, p. 121-130.

Research output: Contribution to journalArticle

Liver Cancer Study Group of Japan. / Treatment Optimization for Hepatocellular Carcinoma in Elderly Patients in a Japanese Nationwide Cohort. In: Annals of surgery. 2019 ; Vol. 270, No. 1. pp. 121-130.
@article{da28ea367109419a9935ecc4ae72fcb7,
title = "Treatment Optimization for Hepatocellular Carcinoma in Elderly Patients in a Japanese Nationwide Cohort",
abstract = "OBJECTIVE: We reviewed nationwide follow-up data to determine outcomes of different treatments for early-stage hepatocellular carcinoma (HCC) in elderly patients. SUMMARY BACKGROUND DATA: Outcomes of early-stage HCC treatments in elderly patients have not been prospectively compared. METHODS: We included 6490 HCC patients, aged ≥75 years at treatment, who underwent curative hepatic resection (HR, n = 2020), radiofrequency ablation (RFA, n = 1888), microwave ablation (MWA, n = 193), or transcatheter arterial chemoembolization (TACE, n = 2389), and compared their characteristics and survival. We used matching propensity score analysis (PSA) between the HR and RFA subgroups with tumors ≤3 cm to overcome baseline bias. RESULTS: The HR group had significantly longer recurrence-free survival (RFS) than the RFA, MWA, and TACE groups [RFA vs HR-hazard ratio: 1.22, 95{\%} confidence interval (CI): 1.09-1.37, P < 0.001; MWA vs HR-hazard ratio: 1.51, 95{\%} CI: 1.22-1.88, P < 0.001; TACE vs HR-hazard ratio: 2.70, 95{\%} CI: 2.44-2.99, P < 0.001). HR and RFA patients had significantly longer overall survival (OS) than the TACE group (RFA vs HR-hazard ratio: 1.01, 95{\%} CI: 0.87-1.17, P = 0.919, TACE vs HR-hazard ratio: 2.11, 95{\%} CI: 1.86-2.40, P < 0.001). PSA successfully matched HR and RFA patients from with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics; and showed significantly longer RFS (hazard ratio: 1.64, 95{\%} CI: 1.29-2.10, P < 0.001) and OS (hazard ratio: 1.57, 95{\%} CI: 1.12-2.20, P = 0.009) for HR than for RFA (including subgroup analyses). In Cox proportional hazard analysis, HR offered better prognosis than RFA. CONCLUSIONS: HR decreases recurrence risk and improves OS in patients aged ≥75 years with primary HCC tumors ≤3.0 cm.",
author = "{Liver Cancer Study Group of Japan} and Masaki Kaibori and Kengo Yoshii and Kiyoshi Hasegawa and Asao Ogawa and Shoji Kubo and Ryosuke Tateishi and Namiki Izumi and Masumi Kadoya and Masatoshi Kudo and Takashi Kumada and Michiie Sakamoto and Osamu Nakashima and Yutaka Matsuyama and Tadatoshi Takayama and Norihiro Kokudo",
year = "2019",
month = "7",
day = "1",
doi = "10.1097/SLA.0000000000002751",
language = "English",
volume = "270",
pages = "121--130",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Treatment Optimization for Hepatocellular Carcinoma in Elderly Patients in a Japanese Nationwide Cohort

AU - Liver Cancer Study Group of Japan

AU - Kaibori, Masaki

AU - Yoshii, Kengo

AU - Hasegawa, Kiyoshi

AU - Ogawa, Asao

AU - Kubo, Shoji

AU - Tateishi, Ryosuke

AU - Izumi, Namiki

AU - Kadoya, Masumi

AU - Kudo, Masatoshi

AU - Kumada, Takashi

AU - Sakamoto, Michiie

AU - Nakashima, Osamu

AU - Matsuyama, Yutaka

AU - Takayama, Tadatoshi

AU - Kokudo, Norihiro

PY - 2019/7/1

Y1 - 2019/7/1

N2 - OBJECTIVE: We reviewed nationwide follow-up data to determine outcomes of different treatments for early-stage hepatocellular carcinoma (HCC) in elderly patients. SUMMARY BACKGROUND DATA: Outcomes of early-stage HCC treatments in elderly patients have not been prospectively compared. METHODS: We included 6490 HCC patients, aged ≥75 years at treatment, who underwent curative hepatic resection (HR, n = 2020), radiofrequency ablation (RFA, n = 1888), microwave ablation (MWA, n = 193), or transcatheter arterial chemoembolization (TACE, n = 2389), and compared their characteristics and survival. We used matching propensity score analysis (PSA) between the HR and RFA subgroups with tumors ≤3 cm to overcome baseline bias. RESULTS: The HR group had significantly longer recurrence-free survival (RFS) than the RFA, MWA, and TACE groups [RFA vs HR-hazard ratio: 1.22, 95% confidence interval (CI): 1.09-1.37, P < 0.001; MWA vs HR-hazard ratio: 1.51, 95% CI: 1.22-1.88, P < 0.001; TACE vs HR-hazard ratio: 2.70, 95% CI: 2.44-2.99, P < 0.001). HR and RFA patients had significantly longer overall survival (OS) than the TACE group (RFA vs HR-hazard ratio: 1.01, 95% CI: 0.87-1.17, P = 0.919, TACE vs HR-hazard ratio: 2.11, 95% CI: 1.86-2.40, P < 0.001). PSA successfully matched HR and RFA patients from with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics; and showed significantly longer RFS (hazard ratio: 1.64, 95% CI: 1.29-2.10, P < 0.001) and OS (hazard ratio: 1.57, 95% CI: 1.12-2.20, P = 0.009) for HR than for RFA (including subgroup analyses). In Cox proportional hazard analysis, HR offered better prognosis than RFA. CONCLUSIONS: HR decreases recurrence risk and improves OS in patients aged ≥75 years with primary HCC tumors ≤3.0 cm.

AB - OBJECTIVE: We reviewed nationwide follow-up data to determine outcomes of different treatments for early-stage hepatocellular carcinoma (HCC) in elderly patients. SUMMARY BACKGROUND DATA: Outcomes of early-stage HCC treatments in elderly patients have not been prospectively compared. METHODS: We included 6490 HCC patients, aged ≥75 years at treatment, who underwent curative hepatic resection (HR, n = 2020), radiofrequency ablation (RFA, n = 1888), microwave ablation (MWA, n = 193), or transcatheter arterial chemoembolization (TACE, n = 2389), and compared their characteristics and survival. We used matching propensity score analysis (PSA) between the HR and RFA subgroups with tumors ≤3 cm to overcome baseline bias. RESULTS: The HR group had significantly longer recurrence-free survival (RFS) than the RFA, MWA, and TACE groups [RFA vs HR-hazard ratio: 1.22, 95% confidence interval (CI): 1.09-1.37, P < 0.001; MWA vs HR-hazard ratio: 1.51, 95% CI: 1.22-1.88, P < 0.001; TACE vs HR-hazard ratio: 2.70, 95% CI: 2.44-2.99, P < 0.001). HR and RFA patients had significantly longer overall survival (OS) than the TACE group (RFA vs HR-hazard ratio: 1.01, 95% CI: 0.87-1.17, P = 0.919, TACE vs HR-hazard ratio: 2.11, 95% CI: 1.86-2.40, P < 0.001). PSA successfully matched HR and RFA patients from with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics; and showed significantly longer RFS (hazard ratio: 1.64, 95% CI: 1.29-2.10, P < 0.001) and OS (hazard ratio: 1.57, 95% CI: 1.12-2.20, P = 0.009) for HR than for RFA (including subgroup analyses). In Cox proportional hazard analysis, HR offered better prognosis than RFA. CONCLUSIONS: HR decreases recurrence risk and improves OS in patients aged ≥75 years with primary HCC tumors ≤3.0 cm.

UR - http://www.scopus.com/inward/record.url?scp=85067787552&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067787552&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000002751

DO - 10.1097/SLA.0000000000002751

M3 - Article

VL - 270

SP - 121

EP - 130

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 1

ER -