Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Zhang, Qiuqiang; Wu, Panyisha; Albahde, Mugahed Abdullah Hasan; Zhang, Lufei; Zhou, Zhuha; Liu, Hua; Li, Yufeng; Wang, Weilin

doi:10.3389/fonc.2020.00479

Cited by 3 publications

(6 citation statements)

References 24 publications

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“…With the improvement of surgical technology and perioperative management, the safety, feasibility, and availability of surgical resection for patients with stage I–II HCC have been widely improved ( 21 , 24 ). In terms of liver resection, our study showed that LR was not associated with better survival than WSR, which is similar to several previous studies ( 6 , 29 ). When determining whether a patient is eligible for surgical resection, one must consider tumor burden, liver function, presence of portal hypertension, and comorbidities, as well as the extent of hepatectomy and the expected volume of the future liver remnant.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, the nodal points of the research interval were also very significant. We ensured that more balanced and rational data were available by choosing from those methods ( 6 , 14 ). Moreover, we conducted subgroup analysis and performed an interaction test to eliminate variables that affected the relationship between surgical therapy and patients’ survival.…”

Section: Discussionmentioning

confidence: 99%

“…Therapy information included surgeries, radiotherapy, and chemotherapy. Patients were divided into five surgery groups: non-surgery, LTD, WSR, LR, and LT ( 6 , 18 ). LTD comprised RFA, cryosurgery, alcohol [percutaneous ethanol injection (PEI)], and photodynamic therapy (PDT).…”

Section: Methodsmentioning

confidence: 99%

“…Radiotherapy and chemotherapy information was converted into two levels (Yes and No). Pathological information included the tumor size, stage, tumor grade, alpha-fetoprotein (AFP) levels, and fibrosis score ( 6 ). AFP was categorized as positive, negative, or unknown (borderline, test not done, not applicable, and unknown) ( 19 ).…”

Section: Methodsmentioning

confidence: 99%

“…For young patients with stage I–II HCC, surgical treatment includes liver resection [wedge or segmental resection (WSR) and lobectomy resection (LR)], liver transplantation (LT), and local tumor destruction (LTD), which may offer curative treatment ( 6 ). The prognosis of patients with HCC depends on the stage of the disease as well as liver function at the time of diagnosis ( 7 ), and young patients tend to have better health conditions and stronger tolerance to curative treatment ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Surgical therapy and survival in young patients with stage I–II hepatocellular carcinoma: a retrospective cohort study

Zhang¹,

Jiang²,

Huang³

et al. 2022

Transl Cancer Res TCR

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Background: Hepatocellular carcinoma (HCC) is regarded as a high-mortality cancer, but the effectiveness of surgical strategies for young patients with early-stage HCC remains controversial. We aimed to analyze the survival in young patients with stage I-II HCC who underwent different kinds of surgical treatments. Methods: Overall survival (OS) and cancer-specific survival (CSS) were compared among patients aged 18-45 years with stage I-II HCC from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2013) who underwent local tumor destruction (LTD), wedge or segmental resection (WSR), lobectomy resection (LR), liver transplantation (LT), or non-surgery. Univariate and multivariate analyses and Kaplan-Meier method were used to examine the OS and CSS of the patients. A stratification analysis of CSS was also conducted among the subgroups.Results: Data from 664 patients were extracted. The median survival time was 46 months. In the multivariate analysis of OS, compared with non-surgery, LTD [hazard ratio (HR), 0.37; 95% confidence interval (CI): 0.25-0.54; P<0.0001], LR (HR, 0.29; 95% CI: 0.19-0.45; P<0.0001), and WSR (HR, 0.26; 95% CI: 0.17-0.39; P<0.0001) had better outcomes, and LT had the best survival benefit (HR, 0.24; 95% CI: 0.16-0.36; P<0.0001), which was similar to CSS. In the stratification analysis, compared with the nonsurgery group, among patients with chemotherapy, LT reduced the risk of CSS by 64% (HR, 0.36; 95% CI: 0.19-0.66; P interaction=0.0004).Conclusions: Surgery offers a survival benefit compared with non-surgery for young patients with stage I-II HCC. LT is associated with better survival than WSR, LR, and LTD.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Surgical therapy and survival in young patients with stage I–II hepatocellular carcinoma: a retrospective cohort study

Zhang¹,

Jiang²,

Huang³

et al. 2022

Transl Cancer Res TCR

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OHCCPredictor: an online risk stratification model for predicting survival duration of older patients with hepatocellular carcinoma

Tan

Lin

et al. 2023

Hepatol Int

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Background Although the elderly constitute more than a third of hepatocellular carcinoma (HCC) patients, they have not been adequately represented in treatment and prognosis studies. Thus, there is not enough evidence to guide the treatment of such patients. The objective of this study is to identify the prognostic factors of older patients with HCC and to construct a new prognostic model for predicting their overall survival (OS). Methods 2,721 HCC patients aged ≥ 65 were extracted from the public database-Surveillance, Epidemiology, and End Results (SEER) and randomly divided into a training set and an internal validation set with a ratio of 7:3. 101 patients diagnosed from 2008 to 2017 in the First Affiliated Hospital of Zhejiang University School of Medicine were identified as the external validation set. Univariate cox regression analyses and multivariate cox regression analyses were adopted to identify these independent prognostic factors. A predictive nomogram-based risk stratification model was proposed and evaluated using area under the receiver operating characteristic curve (AUC), calibration curves, and a decision curve analysis (DCA). Results These attributes including age, sex, marital status, T stage, N stage, surgery, chemotherapy, tumor size, alpha-fetoprotein level, fibrosis score, bone metastasis, lung metastasis, and grade were the independent prognostic factors for older patients with HCC while predicting survival duration. We found that the nomogram provided a good assessment of OS at 1, 3, and 5 years in older patients with HCC (1-year OS: (training set: AUC = 0.823 (95%CI 0.803–0.845); internal validation set: AUC = 0.847 (95%CI 0.818–0.876); external validation set: AUC = 0.732 (95%CI 0.521–0.943)); 3-year OS: (training set: AUC = 0.813 (95%CI 0.790–0.837); internal validation set: AUC = 0.844 (95%CI 0.812–0.876); external validation set: AUC = 0.780 (95%CI 0.674–0.887)); 5-year OS: (training set: AUC = 0.839 (95%CI 0.806–0.872); internal validation set: AUC = 0.800 (95%CI 0.751–0.849); external validation set: AUC = 0.821 (95%CI 0.727–0.914)). The calibration curves showed that the nomogram was with strong calibration. The DCA indicated that the nomogram can be used as an effective tool in clinical practice. The risk stratification of all subgroups was statistically significant (p < 0.05). In the stratification analysis of surgery, larger resection (LR) achieved a better survival curve than local destruction (LD), but a worse one than segmental resection (SR) and liver transplantation (LT) (p < 0.0001). With the consideration of the friendship to clinicians, we further developed an online interface (OHCCPredictor) for such a predictive function (https://juntaotan.shinyapps.io/dynnomapp_hcc/). With such an easily obtained online tool, clinicians will be provided helpful assistance in formulating personalized therapy to assess the prognosis of older patients with HCC. Conclusions Age, sex, marital status, T stage, N stage, surgery, chemotherapy, tumor size, AFP level, fibrosis score, bone metastasis, lung metastasis, and grade were independent prognostic factors for elderly patients with HCC. The constructed nomogram model based on the above factors could accurately predict the prognosis of such patients. Besides, the developed online web interface of the predictive model provide easily obtained access for clinicians.

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Safety and oncological benefits of hepatectomy for hepatocellular carcinoma in octogenarians

Hayashi

Shimizu

Motoyama

et al. 2023

Asian Journal of Surgery

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Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Cited by 3 publications

References 24 publications

Surgical therapy and survival in young patients with stage I–II hepatocellular carcinoma: a retrospective cohort study

Surgical therapy and survival in young patients with stage I–II hepatocellular carcinoma: a retrospective cohort study

OHCCPredictor: an online risk stratification model for predicting survival duration of older patients with hepatocellular carcinoma

Safety and oncological benefits of hepatectomy for hepatocellular carcinoma in octogenarians

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