Abstract
Simple SummaryOlder patients are considered to have increased risk for complications and survival after major surgery, but age alone is not a reliable predictor of post-operative complications and outcomes. To date, no universal screening test adequately predicts postoperative outcomes in older patients. This retrospective study recorded pertinent baseline geriatric assessment variables to identify risk factors for recurrence-free survival (RFS) and overall survival (OS) in hepatocellular carcinoma (HCC) for patients aged ≥70 years who undergo hepatectomy. The change of geriatric 8 (G8) at six months postoperatively was the most significant predictive factor for RFS and OS among various geriatric assessments. G8 score is a useful screening method for older HCC patients who qualify for elective liver resection.This retrospective study recorded pertinent baseline geriatric assessment variables to identify risk factors for recurrence-free survival (RFS) and overall survival (OS) after hepatectomy in 100 consecutive patients aged ≥70 years with hepatocellular carcinoma. Patients had geriatric assessments of cognition, nutritional and functional statuses, and comorbidity burden, both preoperatively and at six months postoperatively. The rate of change in each score between preoperative and postoperative assessments was calculated by subtracting the preoperative score from the score at six months postoperatively, then dividing by the score at six months postoperatively. Patients with score change ≥0 comprised the maintenance group, while patients with score change <0 comprised the reduction group. The change in Geriatric 8 (G8) score at six months postoperatively was the most significant predictive factor for RFS and OS among the tested geriatric assessments. Five-year RFS rates were 43.4% vs. 6.7% (maintenance vs. reduction group; HR, 0.19; 95%CI, 0.11–0.31; p < 0.001). Five-year OS rates were 73.8% vs. 17.8% (HR, 0.12; 95%CI, 0.06–0.25; p < 0.001). Multivariate Cox proportional hazards analysis showed that perioperative maintenance of G8 score was an independent prognostic indicator for both RFS and OS. Perioperative changes in G8 scores can help forecast postoperative long-term outcomes in these patients.
Highlights
Many countries are experiencing an increase in life expectancy, which has led to the worldwide clinical concern in management of malignant diseases in the elderly [1,2,3]
We previously reported that the Geriatric 8 (G8) score, partially based on nutritional assessment, is a useful screening parameter for older Hepatocellular carcinoma (HCC) patients who qualify for elective liver resection
In terms of surgical procedures, anatomic resection was performed in 55% of the patients, while the laparoscopic approach was implemented in 22% of the patients
Summary
Many countries are experiencing an increase in life expectancy, which has led to the worldwide clinical concern in management of malignant diseases in the elderly [1,2,3]. Geriatric Assessment (CGA) is a multidimensional tool that can guide health management for older patients; it can identify patients with higher risk of adverse outcomes through evaluating comorbidities, nutritional status, cognitive status, functional status, and geriatric syndromes [7]. The cumulative incidence of other causes of death among the elderly patients was significantly different from the incidences of HCC-related or liver-related death among the three groups. Age itself should not be a contraindication for hepatic resection treatment of HCC, but the findings suggested that elderly patients with comorbidities should be more stringently selected for surgery. Preoperative liver function tests alone are not sufficient to determine the indications for surgical resection in elderly HCC patients; a comprehensive evaluation of physical and mental functions is essential
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