Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Gut and Liver Pub Date : 2024-07-15 Epub Date: 2024-05-07 DOI:10.5009/gnl230485

Jin-Soo Lee, Dong Ah Park, Seungeun Ryoo, Jungeun Park, Gi Hong Choi, Jeong-Ju Yoo

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Abstract

Background/aims: : With increased life expectancy, the management of elderly hepatocellular carcinoma (HCC) patients became a crucial issue, yet it is still challenging due to comorbidities and high surgical risks. While surgical resection is considered as primary treatment for eligible HCC patients, systematic evidence on its outcomes in elderly patients remains scarce. In this review, we aimed to analyze the efficacy and safety outcomes of surgical resection in elderly HCC patients.

Methods: : The studies included in this meta-analysis were selected from Ovid-MEDLINE, Ovid-Embase, CENTRAL, KoreaMed, KMbase, and KISS databases following a predefined protocol. Efficacy outcomes included overall survival and disease-free survival, while the safety outcomes included postoperative mortality and complications.

Results: : Patients in the elderly group (≥65 years) who underwent surgery exhibited non-inferior overall survival (hazard ratio [HR], 1.26; 95% confidence interval [CI], 0.92 to 1.74) and disease-free survival (HR, 1.03; 95% CI, 0.99 to 1.08) compared to the non-elderly group. Overall postoperative mortality exhibited no statistical difference (odds ratio [OR], 1.07; 95% CI, 0.87 to 1.31), but 30-day, 90-day, and in-hospital mortality were higher in the elderly group. The incidence of overall complications was higher in the elderly group (OR, 1.44; 95% CI, 1.22 to 1.69). Sensitivity analysis for the super elderly group (≥80 years) showed significantly higher in-hospital mortality compared to the non-super elderly group (OR, 2.51; 95% CI, 1.16 to 5.45).

Conclusions: : The efficacy outcome of surgical resection in the elderly HCC patients was not worse than that in the non-elderly HCC patients, while in-hospital mortality and complications rates were higher. Therefore, surgical resection should be purposefully considered in the elderly population, with careful candidate selection.

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肝细胞癌老年患者手术切除的疗效和安全性：系统回顾和 Meta 分析。

背景/目的：：随着预期寿命的延长，老年肝细胞癌（HCC）患者的治疗已成为一个关键问题，但由于合并症和高手术风险，老年肝细胞癌患者的治疗仍具有挑战性。虽然手术切除被认为是符合条件的 HCC 患者的主要治疗方法，但有关其在老年患者中疗效的系统性证据仍然很少。本综述旨在分析老年 HCC 患者手术切除的疗效和安全性：本荟萃分析所纳入的研究按照预定方案从 Ovid-MEDLINE、Ovid-Embase、CENTRAL、KoreaMed、KMbase 和 KISS 数据库中选出。疗效结果包括总生存率和无病生存率，安全性结果包括术后死亡率和并发症：结果：与非老年组相比，老年组（≥65 岁）患者接受手术的总生存率（危险比 [HR]，1.26；95% 置信区间 [CI]，0.92 至 1.74）和无病生存率（HR，1.03；95% CI，0.99 至 1.08）均不低于非老年组。术后总死亡率无统计学差异（几率比 [OR]，1.07；95% CI，0.87 至 1.31），但老年组的 30 天、90 天和住院死亡率较高。老年组的总体并发症发生率更高（OR，1.44；95% CI，1.22 至 1.69）。针对超高龄组（≥80 岁）的敏感性分析显示，与非超高龄组相比，超高龄组的院内死亡率明显更高（OR，2.51；95% CI，1.16 至 5.45）：老年 HCC 患者手术切除的疗效并不比非老年 HCC 患者差，但院内死亡率和并发症发生率较高。因此，老年患者应慎重考虑手术切除。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gut and Liver 医学-胃肠肝病学

CiteScore

7.50

自引率

8.80%

发文量

119

审稿时长

6-12 weeks

期刊介绍： Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut and Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. Gut and Liver is jointly owned and operated by 8 affiliated societies in the field of gastroenterology, namely: the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, the Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, the Korean Pancreatobiliary Association, and the Korean Society of Gastrointestinal Cancer.