Treatment Optimization for Hepatocellular Carcinoma in Elderly Patients in a Japanese Nationwide Cohort.
Ann Surg
; 270(1): 121-130, 2019 07.
Article
em En
| MEDLINE
| ID: mdl-29608544
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 ≤3âcm 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 ≤3.0âcm 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 ≤3.0âcm.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Quimioembolização Terapêutica
/
Ablação por Cateter
/
Carcinoma Hepatocelular
/
Hepatectomia
/
Neoplasias Hepáticas
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article