Outcomes in elderly patients undergoing hepatic resection compared to liver transplant for hepatocellular carcinoma
© 2023 Wiley Periodicals LLC..
BACKGROUND: Hepatic resection (HR) is an excellent option for patients with hepatocellular carcinoma (HCC). For patients meeting the Milan criteria, a liver transplant (LT) is also a viable option for patients with HCC, especially those with end-stage liver disease. With increasing rates of LTs amongst the elderly, we sought to determine long-term outcomes in patients who underwent HR compared to LTs in this patient population.
METHODS: We queried the national cancer database for elderly patients (≥70 years) diagnosed with HCC between 2004 and 2020. The primary outcome was overall survival (OS) computed using the Kaplan-Meier method and Cox proportional hazard regression. One-to-one propensity score matching was conducted on the basis of clinicodemographic features to account for baseline differences between patients undergoing each procedure.
RESULTS: Of the 5090 patients included, 4674 (91.8%) and 416 (8.2%) patients underwent HR and LT, respectively. Compared with HR patients, patients receiving LT had better OS (p < 0.001) and greater median survival time (65.6 months HR vs. 97.9 months LT, p < 0.001). On multivariable analysis, a LT was independently associated with improved survival (adjusted hazard ratio: 0.61, 95% confidence interval: 0.50-0.76, p < 0.001).
CONCLUSIONS: LT is associated with improved survival for well-selected elderly patients with HCC. Age alone should not be used as the sole parameter for the candidacy of LT in elderly patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:128 |
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| Enthalten in: |
Journal of surgical oncology - 128(2023), 8 vom: 01. Dez., Seite 1320-1328 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Khan, Sameer A [VerfasserIn] |
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| Links: |
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| Themen: |
Hepatectomy |
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| Anmerkungen: |
Date Completed 15.11.2023 Date Revised 15.11.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/jso.27430 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM361365195 |
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| 245 | 1 | 0 | |a Outcomes in elderly patients undergoing hepatic resection compared to liver transplant for hepatocellular carcinoma |
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| 500 | |a Date Revised 15.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: Hepatic resection (HR) is an excellent option for patients with hepatocellular carcinoma (HCC). For patients meeting the Milan criteria, a liver transplant (LT) is also a viable option for patients with HCC, especially those with end-stage liver disease. With increasing rates of LTs amongst the elderly, we sought to determine long-term outcomes in patients who underwent HR compared to LTs in this patient population | ||
| 520 | |a METHODS: We queried the national cancer database for elderly patients (≥70 years) diagnosed with HCC between 2004 and 2020. The primary outcome was overall survival (OS) computed using the Kaplan-Meier method and Cox proportional hazard regression. One-to-one propensity score matching was conducted on the basis of clinicodemographic features to account for baseline differences between patients undergoing each procedure | ||
| 520 | |a RESULTS: Of the 5090 patients included, 4674 (91.8%) and 416 (8.2%) patients underwent HR and LT, respectively. Compared with HR patients, patients receiving LT had better OS (p < 0.001) and greater median survival time (65.6 months HR vs. 97.9 months LT, p < 0.001). On multivariable analysis, a LT was independently associated with improved survival (adjusted hazard ratio: 0.61, 95% confidence interval: 0.50-0.76, p < 0.001) | ||
| 520 | |a CONCLUSIONS: LT is associated with improved survival for well-selected elderly patients with HCC. Age alone should not be used as the sole parameter for the candidacy of LT in elderly patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a hepatectomy | |
| 650 | 4 | |a hepatocellular carcinoma | |
| 650 | 4 | |a liver transplant | |
| 700 | 1 | |a Ahmed, Fasih A |e verfasserin |4 aut | |
| 700 | 1 | |a Hafeez, Muhammad S |e verfasserin |4 aut | |
| 700 | 1 | |a Feng, Lawrence R |e verfasserin |4 aut | |
| 700 | 1 | |a Seth, Abhinav |e verfasserin |4 aut | |
| 700 | 1 | |a Kwon, Yong K |e verfasserin |4 aut | |
| 700 | 1 | |a Aziz, Hassan |e verfasserin |4 aut | |
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