TY - JOUR
T1 - Impact of Advanced Age on Survival in Patients Undergoing Resection of Hepatocellular Carcinoma
T2 - Report of a Japanese Nationwide Survey
AU - Liver Cancer Study Group of Japan
AU - Kaibori, Masaki
AU - Yoshii, Kengo
AU - Yokota, Isao
AU - Hasegawa, Kiyoshi
AU - Nagashima, Fumio
AU - Kubo, Shoji
AU - Kon, Masanori
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 - 2019/4/1
Y1 - 2019/4/1
N2 - OBJECTIVE: The impact of age on survival after hepatic resection for hepatocellular carcinoma (HCC) has not been thoroughly examined. We reviewed the data of a nationwide follow-up survey to determine the outcomes of hepatectomy for HCC in elderly patients. BACKGROUND: Management of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for liver surgery. METHODS: In all, 12,587 patients with HCC who underwent curative hepatic resection were included in this cohort study and classified according to age group [40-59 years (n = 2991), 60-74 years (n = 7576,), and ≥75 years (n = 2020)]. Clinicopathological features, long-term survival, and cumulative incidences of death after hepatic resection were compared among the groups. The cause-specific subdistribution hazard ratios for 3 types of death depending on age were also estimated. RESULTS: Preoperative liver function tests showed that the prothrombin activity and platelet count were higher in the ≥75-year age group than in the other age groups. The overall survival was significantly lower in the elderly than younger patients. However, recurrence-free survival was almost identical among the 3 groups. The cumulative incidence of HCC-related or liver-related death was almost identical among the 3 groups; however, the cumulative incidence of other causes of death was significantly different. The 60-year subdistribution hazard ratio for other causes of death increased remarkably with increasing age. CONCLUSIONS: Elderly patients in this nationwide survey had significantly worse overall survival after hepatectomy than middle-aged and young patients. The cumulative incidence of other causes of death in elderly patients was significantly different from that of HCC-related or liver-related death among the 3 groups.
AB - OBJECTIVE: The impact of age on survival after hepatic resection for hepatocellular carcinoma (HCC) has not been thoroughly examined. We reviewed the data of a nationwide follow-up survey to determine the outcomes of hepatectomy for HCC in elderly patients. BACKGROUND: Management of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for liver surgery. METHODS: In all, 12,587 patients with HCC who underwent curative hepatic resection were included in this cohort study and classified according to age group [40-59 years (n = 2991), 60-74 years (n = 7576,), and ≥75 years (n = 2020)]. Clinicopathological features, long-term survival, and cumulative incidences of death after hepatic resection were compared among the groups. The cause-specific subdistribution hazard ratios for 3 types of death depending on age were also estimated. RESULTS: Preoperative liver function tests showed that the prothrombin activity and platelet count were higher in the ≥75-year age group than in the other age groups. The overall survival was significantly lower in the elderly than younger patients. However, recurrence-free survival was almost identical among the 3 groups. The cumulative incidence of HCC-related or liver-related death was almost identical among the 3 groups; however, the cumulative incidence of other causes of death was significantly different. The 60-year subdistribution hazard ratio for other causes of death increased remarkably with increasing age. CONCLUSIONS: Elderly patients in this nationwide survey had significantly worse overall survival after hepatectomy than middle-aged and young patients. The cumulative incidence of other causes of death in elderly patients was significantly different from that of HCC-related or liver-related death among the 3 groups.
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U2 - 10.1097/SLA.0000000000002526
DO - 10.1097/SLA.0000000000002526
M3 - Article
C2 - 28922205
AN - SCOPUS:85057090149
VL - 269
SP - 692
EP - 699
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 4
ER -