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Liver resection in elderly patients with hepatocellular carcinoma: age does matter

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Abstract

Increasing proportions of elderly patients with hepatocellular carcinoma (HCC) requiring oncological treatment have been noted. We aim to evaluate the impact of elderly age on outcomes of liver resection (LR) for HCC. This retrospective study enrolled 1004 patients with HCC who underwent curative LR in our institution from 2007 to 2017, dividing them into three groups according to age (18–59 years, n = 461; 60–74 years, n = 447; ≥ 75 years, n = 96). Elderly patients were defined as those ≥ 75 years old. Outcomes were then compared among the three groups, with a multivariate competing risk model used to estimate cause-specific subdistribution hazard ratios (SHRs) for HCC- and non-HCC-related deaths. The OS was significantly lower in the elderly than younger patients. However, recurrence-free survival was similar among the three groups. The cumulative incidence of HCC-related death was similar among the three groups; however, the cumulative incidence of non-HCC-related death was significantly higher in the elderly than younger patients. Moreover, the multivariate analysis showed that elderly age was not an independent variable associated with HCC-related death. However, elderly age was an independent variable associated with non-HCC-related death. The 60-year SHR for non-HCC-related death increased with increasing age. The elderly patients had significantly worse OS after LR than the younger patients, possibly due to the cumulative incidence of non-HCC-related death being significantly higher among the elderly than among the younger patients. Elderly patients should be more stringently selected for LR.

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Acknowledgements

The authors thank Cancer Center, Kaohsiung Chang Gung Memorial Hospital for the provision of HCC registry data. The authors thank Chih-Yun Lin and Nien-Tzu Hsu and the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital for statistics work. This study was supported by Grant CMRPG8J1281 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan. No conflict of interests.

Funding

This study was supported by Grant CMRPG8J1281 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.

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Authors and Affiliations

  1. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Yueh-Wei Liu, Chee-Chien Yong, Chih-Che Lin, Chih-Chi Wang & Chao-Long Chen

  2. Liver Transplantation Center, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yu-Fan Cheng

  3. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan

    Jing-Houng Wang & Yi-Hao Yen

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  1. Yueh-Wei Liu
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  2. Chee-Chien Yong
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  8. Yi-Hao Yen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Chih-Chi Wang] and [Yi-Hao Yen]. The first draft of the manuscript was written by [Yueh-Wei Liu] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yi-Hao Yen.

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The authors have no conflicts of interest to disclose for all authors.

Human and animal rights

The Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital approved this study (IRB number: 202000398B0).

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The IRB waived the need for informed consent.

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Liu, YW., Yong, CC., Lin, CC. et al. Liver resection in elderly patients with hepatocellular carcinoma: age does matter. Updates Surg 73, 1371–1380 (2021). https://doi.org/10.1007/s13304-021-01021-7

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  • DOI: https://doi.org/10.1007/s13304-021-01021-7

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