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Major Hepatectomy in Elderly Patients with Large Hepatocellular Carcinoma: A Multicenter Retrospective Observational Study

Authors Chen ZL, Zhang CW, Liang L, Wu H, Zhang WG, Zeng YY, Gu WM, Chen TH, Li J, Zhang YM, Wang H, Zhou YH, Li C, Diao YK, Lau WY, Wu MC, Shen F, Yang T, Liang YJ

Received 14 April 2020

Accepted for publication 12 June 2020

Published 9 July 2020 Volume 2020:12 Pages 5607—5618


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Ahmet Emre Eskazan

Zheng-Liang Chen,1,* Cheng-Wu Zhang,2,* Lei Liang,2,* Han Wu,3,* Wan-Guang Zhang,4 Yong-Yi Zeng,5 Wei-Min Gu,6 Ting-Hao Chen,7 Jie Li,8 Yao-Ming Zhang,9 Hong Wang,10 Ya-Hao Zhou,11 Chao Li,2 Yong-Kang Diao,2 Wan Yee Lau,3,12 Meng-Chao Wu,3 Feng Shen,3 Tian Yang,3 Ying-Jian Liang1

1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, People’s Republic of China; 2Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Zhejiang, People’s Republic of China; 3Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital (Navy Medical University), Second Military Medical University, Shanghai, People’s Republic of China; 4Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 5Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, People’s Republic of China; 6The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, People’s Republic of China; 7Department of General Surgery, Ziyang First People’s Hospital, Sichuan, People’s Republic of China; 8Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Anhui, People’s Republic of China; 9The 2nd Department of Hepatobiliary Surgery, Meizhou People’s Hospital, Guangdong, People’s Republic of China; 10Department of General Surgery, Liuyang People’s Hospital, Hunan, People’s Republic of China; 11Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Yunnan, People’s Republic of China; 12Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ying-Jian Liang
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Road, Heilongjiang 150006, People’s Republic of China
Tian Yang
Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), No. 225, Changhai Road, Shanghai 200438, People’s Republic of China

Background: With an increase in life expectancy and improvement of surgical safety, more elderly patients with hepatocellular carcinoma (HCC), even with large tumors, are now considered for hepatectomy. This study aimed to clarify the impact of age on short- and long-term outcomes after major hepatectomy (≥ 3 segments) for large HCC (≥ 5 cm).
Patients and Methods: Using a multicenter database, patients who underwent curative-intent major hepatectomy for large HCC between 2006 and 2016 were identified. Postoperative morbidity and mortality, overall survival (OS) and recurrence-free survival (RFS) were compared between the elderly (≥ 65 years) and younger (< 65 years) patients. Univariable and multivariable Cox-regression analyses were performed to identify the risk factors of OS and RFS in the entire and elderly cohorts, respectively.
Results: Of 830 patients, 92 (11.1%) and 738 (88.9%) were elderly and younger patients, respectively. There were no significant differences in postoperative 30-day mortality and morbidity between the two groups (5.4% vs 2.6% and 43.5% vs 38.3%, both P> 0.05). The 5-year OS and RFS rates in elderly patients were also comparable to younger patients (35.0% vs 33.2% and 20.0% vs 20.8%, both P> 0.05). In the entire cohort, multivariable Cox-regression analyses identified that old age was not independently associated with OS and RFS. However, in the elderly cohort, preoperative alpha-fetoprotein level > 400 μg/L, multiple tumors, macrovascular invasion and microvascular invasion were independently associated with decreased OS and RFS.
Conclusion: Carefully selected elderly patients benefited from major hepatectomy for large HCC as much as younger patients, and their long-term prognosis was determined by preoperative alpha-fetoprotein level, tumor number and presence of macro- or micro-vascular invasion.

Keywords: hepatocellular carcinoma, hepatectomy, survival, recurrence, elderly

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