Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

Schiergens, Tobias S.; Lindenthaler, Andrea; Thomas, Michael; Rentsch, Markus; Mittermeier, Laura; Brand, Katharina; Küchenhoff, Helmut; Lee, Serene M. L.; Guba, Markus; Werner, Jens; Thasler, Wolfgang E.

doi:10.1111/liv.13068

Cited by 16 publications

(17 citation statements)

References 50 publications

(84 reference statements)

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“…In addition, with the improvement of survival of cancer patients, most of patients with CHCC are faced with advanced ages, which are associated with an increasing high rate of comorbidities. Moreover, ta high risk of competing events, which might contribute to more competing deaths, was observed in patients with CHCC as the age increases [14, 15]. Thus, when prognosis is evaluated, competing risks are worthy of being considered.…”

Section: Introductionmentioning

confidence: 99%

Competing risk analyses of overall survival and cancer-specific survival in patients with combined hepatocellular cholangiocarcinoma after surgery

Zhang

Cai

et al. 2019

BMC Cancer

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Background Our objective was to identify risk factors affecting overall survival (OS) and cancer-specific survival (CSS) and build nomograms to predict survival based on a large population-based cohort. Methods Two hundred and thirty patients diagnosed with CHCC between 2004 and 2015 were retrospectively extracted from the Surveillance, Epidemiology, and End Results (SEER) database as a training cohort. In addition, Ninety-nine patients diagnosed with CHCC between 2000 and 2017 were retrospectively extracted from Sun Yat-Sen University Cancer Center (SYSUCC) as an external validation. Nomograms for predicting probability of OS and CSS were established. Performance of the nomograms was measured by concordance index (C-index) and the area under receiver operating characteristic (ROC) curve (AUC). Results In training cohort, the 1-, 2 and 3-year OS were 67.7, 46.8 and 37.9%, and the 1-, 2 and 3-year CSS were 73.1, 52.0 and 43.0%, respectively. The established nomograms were well calibrated in both training and validation cohort, with concordance indexes (C-index) of 0.652 and 0.659, respectively for OS prediction; 0.706 and 0.763, respectively for CSS prediction. Nomograms also displayed better discriminatory compared with 8th edition tumor-node-metastasis (TNM) stage system for predicting OS and CSS. Conclusion We constructed nomograms to predict OS and CSS based on a relatively large cohort. The established nomograms were well validated and could serve to improve predictions of survival risks and guide management of patients with CHCC after surgery.

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Section: Introductionmentioning

confidence: 99%

Competing risk analyses of overall survival and cancer-specific survival in patients with combined hepatocellular cholangiocarcinoma after surgery

Zhang

Cai

et al. 2019

BMC Cancer

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“…However, studies analyzing long-term recurrence-free survival in relation to earlier complications did not focus on the assessment of pre-existing comorbidities. Furthermore, following liver resection for various indications, our group was previously able to prove the significance of comorbidities for longterm overall survival [34,35]. Recent studies from Taiwan and Nanjing also discussed the use of the CCI in the context of liver resection for HCC.…”

Section: Discussionmentioning

confidence: 98%

Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role?

Khandoga¹,

Drefs²,

Schoenberg³

et al. 2017

European Journal of Gastroenterology &Amp; Hepatology

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“…Recently, one study showed that significantly fewer years of life were lost in patients > 70 years old than in patients < 70 years old, although the 10-year survival rate in patients > 70 years old was significantly poorer than that in patients < 70 years old [31]. Furthermore, another study that evaluated the confounder-adjusted and time-dependent effect of age and comorbidities on overall survival concluded that hepatectomy for HCC should not be denied due to age and comorbidities [32]. Those results suggested that hepatectomy in the elderly can be justified and provide a survival benefit at a reasonable cost.…”

Section: Discussionmentioning

confidence: 99%

The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

et al. 2018

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Background: With aging populations increasing in developed countries, the prevalence of elderly patients with hepatocellular carcinoma (HCC) is expected to rise. The aim of this study was to determine the short- and long-term outcomes of HCC surgery in elderly patients (≥75 years) using propensity score matching. Methods: The study group included 421 patients who underwent hepatectomy as their initial treatment with curative intent. The patients were divided into elderly (n = 111) and non-elderly (n = 310) groups. We applied propensity score matching – taking into consideration patient background, blood examination, and tumor factors – to minimize the effect of potential confounders. We then compared the results before and after the propensity matching. Results: Before propensity matching, the elderly group included significantly more patients with a high American Society of Anesthesiologists physical status (p < 0.001). In addition, they were taking antihypertensive drugs or an anticoagulant (both p < 0.001). The severe postoperative complications and the overall survival rates for these elderly patients were significantly poorer than for the non-elderly patients (p = 0.015 and p = 0.030, respectively). We then chose 70 patients from each group for whom the preoperative confounding factors were balanced and compared the two groups. The factors identified before matching (severe complications and overall survival rates) were no longer relevant, i.e. there were no significant differences between the two groups. Conclusion: Hepatectomy for HCC in elderly patients is justified.

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Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

Abstract: With regard to long-term outcome, liver resection for both primary and secondary malignancies should not be categorically denied due to age and comorbidities. This information should be considered for the patient selection process and informed consent.

Cited by 16 publications

References 50 publications

Competing risk analyses of overall survival and cancer-specific survival in patients with combined hepatocellular cholangiocarcinoma after surgery

Competing risk analyses of overall survival and cancer-specific survival in patients with combined hepatocellular cholangiocarcinoma after surgery

Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role?

The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

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