Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models

Guangzhi Zhu,Shuqi Zhao,Liping Yan,Zijun Chen,Hao Su,Tao Peng,Tianyi Liang,Yongfei He,Chuangye Han,Xin Zhou,Shutian Mo,Xiangkun Wang

doi:10.1186/s12876-021-01815-4

Abstract

BackgroundThe effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients.MethodsA retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed.Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival.ConclusionsWe demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

Highlights

Primary hepatocellular carcinoma (HCC) is a common malignancy of the digestive tract worldwide and the second leading cause of cancer-related deaths [1]
Recent studies have shown that a moderate delay in the treatment of liver cancer patients does not affect the prognosis of patients [5], which is similar to the results obtained in lung cancer, thyroid cancer, and colorectal cancer [7]
The results showed that Body Mass Index (BMI), Child-Pugh Classification, Tumor size Max, Clavien Dindo, and Length of stay were related to the prognosis of the patients, and time to surgery (TTS) did not significantly affect the overall survival (OS) of the patients (Table 2)

Summary

Introduction

Primary hepatocellular carcinoma (HCC) is a common malignancy of the digestive tract worldwide and the second leading cause of cancer-related deaths [1]. Only a few scholars have studied and analyzed the impact of delayed surgical treatment on the prognosis of patients with HCC, of which only one study employed surgery as the only intervention factor [4,5,6]. Most studies have shown that delaying the time of intervention treatment leads to poor prognosis of patients [3]. The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients

Methods

Results

Discussion

Conclusion