Research Paper Volume 11, Issue 5 pp 1537—1550

Hepatic resection for hepatocellular carcinoma in the octogenarian: is it justified?

Chao-Wei Lee 1, 2, 3, , Kun-Ming Chan 1, , Hsin-I Tsai 2, 3, 4, , Yi-Chung Hsieh 5, , Cheng-Yu Lin 6, , Yung-Chia Kuo 2, 3, 7, , Heng-Yuan Hsu 1, , Ming-Chin Yu 1, 2, 3, ,

  • 1 Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
  • 2 College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
  • 3 Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan
  • 4 Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
  • 5 Division of Hepatology, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
  • 6 Division of Gastroenterology, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan
  • 7 Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan

received: November 9, 2018 ; accepted: March 6, 2019 ; published: March 13, 2019 ;

https://doi.org/10.18632/aging.101854
How to Cite

Copyright: Lee et al. This is an open‐access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Liver resection is a standard treatment for hepatocellular carcinoma (HCC). The purpose of this study was to investigate the clinicopathological characteristics and long-term outcomes of octogenarians with HCC treated with liver resection. Records of patients who underwent liver resection for HCC were reviewed, and patients older and younger than 80 years were compared. There were 77 patients 80 years of age or older and 3,309 younger than 80 years. Hepatitis C virus infection was the most common etiology among the octogenarians (43.1%), followed by non-viral causes (37.5%). The older group had more co-morbidity but less hepatitis B virus infection and cirrhosis. More than 70% of the non-viral older group had diabetes mellitus, as compared to only 21.6% in the viral older group. The older group had rates of perioperative morbidity, mortality, disease-free survival, and overall survival comparable to the younger group (all p>0.1). Multivariate analysis revealed that α-fetoprotein ≥400 ng/mL, tumor size ≥10 cm, and vascular invasion were independent prognostic factors for overall survival in the older patients. These findings demonstrate that liver resection is a justified treatment for HCC in octogenarians, and it can achieve surgical outcomes comparable to those in younger populations.

Abbreviations

HCC: hepatocellular carcinoma; O-HCC: HCC patients older than 80 year-old; Y-HCC: HCC patients younger than 80 year-old; HCV: hepatitis C virus; DM: diabetes mellitus; NASH: nonalcoholic steatohepatitis; OS: overall survival; DFS: disease free survival; CGMH: Chang Gung Memorial Hospital; AJCC: American Joint Committee on Cancer; CT: computed tomography; MRI: magnetic resonance imaging; ICG-R15: indocyanine green retention test at 15 min; ECOG: Eastern Cooperative Oncology Group; CUSA: cavitron ultrasonic surgical aspirator; HR: hazard ratios; CI: confidence intervals; HBV: hepatitis B virus; INR: international normalized ratio.