Abstract
ObjectivesThe aim was to evaluate the prognostic factors, clinicopathological characteristics, and surgical outcomes after hepatectomy in very elderly patients with hepatocellular carcinoma (HCC).MethodsWe analyzed 796 patients with HCC from 2000 to 2017. Patients aged 80 years or older were classified into the very elderly group (group VE; n = 49); patients younger than 80 years old and aged 65 years or older were classified into the elderly group (group E; n = 363), and patients younger than 65 years old were classified into the young group (group Y; n = 384). We investigated the prognoses, clinicopathological characteristics, and surgical outcomes after hepatectomy.ResultsThe number of surgical procedures and outcomes, including morbidities, was not significantly different. Groups VE, E, and Y showed similar prognoses in terms of both survival and recurrence. In group VE, prothrombin activity (PA) < 80% and PIVKA-II ≥ 400 mAU/ml were unfavorable factors for survival, and PIVKA-II ≥ 400 mAU/ml and the presence of portal venous invasion (PVI), hepatic venous invasion, and fibrosis were unfavorable factors for recurrence. In group E, ChE < 180 IU/l, AFP ≥ 20 ng/ml, tumor size ≥ 10 cm, and the presence of multiple tumors, PVI, and hepatic venous invasion (HVI) were unfavorable factors for survival, and ChE < 180 IU/l, tumor size ≥ 10 cm, and the presence of multiple tumors, PVI, and HVI were unfavorable factors for recurrence. In group Y, AFP ≥ 20 ng/ml, the presence of multiple tumors, poor differentiation, PVI, HVI, and blood loss ≥ 400 ml were unfavorable factors for survival, and PA < 80%, albumin < 3.5 g/dl, AFP ≥ 20 ng/ml, tumor size ≥ 10 cm, and the presence of multiple tumors, poor differentiation, and PVI were unfavorable factors for recurrence.ConclusionsTumor factors might have limited influence on the prognosis of very elderly patients, and liver function reserve might be important for the long-term survival of very elderly patients. Hepatectomy can be performed safely, even in very elderly patients. Hepatectomy should not be avoided in very elderly patients with HCC if patients have a good general status because these patients have the same prognoses as nonelderly individuals.
Highlights
It is estimated that 18.1 million new cancer cases and 9.6 million cancer deaths occurred in 2018 worldwide [1]
Future remnant liver rates in pretty elderly patients who underwent hepatectomy We evaluated the future remnant liver rate (FRLR) in group VE
Our present study indicated that the number of patients in group VE increased in the late period (2009–2017) and that there were an increased proportion of patients with HCV and patients without HBV and HCV
Summary
It is estimated that 18.1 million new cancer cases and 9.6 million cancer deaths occurred in 2018 worldwide [1]. Liver cancer is the seventh most frequent type of cancer with an estimated 841,080 cases per year and the second leading cause of cancer-related death; liver cancer is responsible for approximately 781,631 deaths per year [1]. Hepatocellular carcinoma (HCC) has a poor prognosis and accounts for 70–85% of primary liver cancers [2]. The incident rate of liver cancer in Japan was 23.8% per 100, 000 men and 8.6% per 100,000 women [3]. According to the report from the Liver Cancer Study Group of Japan, 6940 liver resections and 122 liver transplantations for HCC occurred between 2008 and 2009 [4].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
