Comparison of surgical resection and radiofrequency ablation for stages I and II elderly hepatocellular carcinoma patients (≥ 65 years): A SEER population-based propensity score matching’s study

Abstract

ObjectivesThe treatment for hepatocellular carcinoma (HCC) remains controversial and limited in elderly patients. Therefore, we aimed to explore treatment choices for the elderly patients (≥ 65years) following surgical resection (SR) versus radiofrequency ablation (RFA) with HCC (single lesion less than 5 cm).MethodsWe used SEER database to identify HCC patients who received treatment of SR/RFA. Kaplan–Meier method and Cox proportional hazards regression method were used to determine the prognostic factors associated with overall survival (OS) and disease-specific survival (DSS). In addition, RFA group and SR group patients were matched with 1:1 propensity score matching (PSM) for diagnosis age, sex, race, marital, American Joint Committee on Cancer (AJCC), grade, radiotherapy, and chemotherapy to decrease the possibility of selection bias. Conditional disease-specific survival (CS) was estimated using the life-table method.ResultsA total of 794 patients who underwent SR and 811 patients who underwent RFA were confirmed from the SEER database. Surgery type was an independent risk factor for HCC. Survival analysis indicated that SR, races, AJCC I, no chemotherapy treatment, and grade I were cumulative risk factors that can significantly improve median survival for HCC (P < 0.05). After PSM analysis, only surgery type was significantly improved median survival of HCC patients (SR vs. RFA, HR: 0.644, 95% CI: 0.482–0.86; P < 0.001). For RFA group, the 2-, 3-, and 5-year CS rates were approximately 71%, 65%, and 62%, respectively, and corresponding to 82%, 80%, and 78% in the SR group.ConclusionSR treatment can provide survival benefits for elderly patients of <5 cm single lesion HCC.

Landmark analysis of the risk of recurrence after resection or ablation for HCC: A nationwide study

“…Reviewing the literature, we found no prior landmark analyses of the risk of recurrence or of death without recurrence following curative-intent treatments for HCC. However, 5 prior studies have conducted survival landmark analyses following resection, [16][17][18][19][20] and one of these studies also presented landmark analyses following ablation. [20] The patient populations in the 5 studies differ substantially in geography, HCC stage, HCC grade, cirrhosis, tumor size, and microvascular invasion, complicating attempts to compare their results.…”

“…However, 5 prior studies have conducted survival landmark analyses following resection, [16][17][18][19][20] and one of these studies also presented landmark analyses following ablation. [20] The patient populations in the 5 studies differ substantially in geography, HCC stage, HCC grade, cirrhosis, tumor size, and microvascular invasion, complicating attempts to compare their results. With that caveat in mind, the existing literature generally indicates a stable survival over the landmarks following both resection and ablation, and that is consistent with what we show in Figure 2 (bottom) and Supplemental Figure S1, http://links.lww.com/HC9/A939.…”

Construction of a Nomogram to Predict Overall Survival in Patients with Early-Onset Hepatocellular Carcinoma: A Retrospective Cohort Study

“…Tumor size is a significant factor that influences the prognosis of hepatocellular carcinoma (HCC), and it is commonly used as a crucial criterion for HCC staging and treatment guidelines [24]. Several multicenter studies focusing on surgically-resected HCC have consistently demonstrated that tumors measuring >5 cm are associated with a poorer prognosis than those measuring ≤5 cm [25][26][27]. The nomogram clearly illustrates the rela-tionship between the tumor size and prognosis, indicating that as the tumor size increases, the corresponding score also increases, indicating a worse prognosis.…”