Elizabeth M Garcia, Sanjna N Nerurkar, Eunice X Tan, Shaun Ys Tan, Ern-Wei Peck, Sabrina Xz Quek, Readon Teh, Margaret Teng, Andrew Tran, Ee Jin Yeo, Michael Le, Connie Wong, Ramsey Cheung, Daniel Q Huang
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引用次数: 0
Abstract
Background & aims: Due to ageing of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence free survival (RFS) and complication rates in elderly HCC patients undergoing resection.
Methods: We searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020 for studies reporting outcomes in elderly (age ≥ 65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.
Results: We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI 72.89-76.02), 75.54% were male (95% CI 72.53-78.32) and 66.73% had cirrhosis (95% CI 43.93-83.96). The mean tumor size was 5.50 cm (95% CI 4.71-6.29) and 16.01% had multiple tumors (95% CI 10.74-23.19). The 1-year (86.02% versus 86.66%, p=0.84) and 5-year OS (51.60% versus 53.78%) between non-elderly versus elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% versus 73.26%, p=0.11) and 5-year RFS (31.57% versus 30.25%, p=0.67) in non-elderly versus elderly patients. There was a higher rate of minor complications (21.95% versus 13.71%, p=0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p=0.43) Conclusion: This data shows that overall survival, recurrence and major complications after liver resection for HCC are comparable between elderly and non-elderly patients, and may inform clinical management of HCC in this population.
背景与目的:由于全球人口老龄化，肝细胞癌(HCC)在老年患者中越来越常见，但治疗性肝切除术后的预后尚不清楚。采用荟萃分析方法，我们旨在评估老年HCC切除术患者的总生存期(OS)、无复发生存期(RFS)和并发症发生率。方法:我们检索了PubMed、Embase和Cochrane数据库，从开始到2020年11月10日，研究报告了老年(年龄≥65岁)HCC患者接受根治性手术切除的结果。使用随机效应模型生成汇总估计。结果:我们筛选了8598篇文章，包括42项研究(7778名老年患者)。平均年龄为74.45岁(95% CI 72.89-76.02)， 75.54%为男性(95% CI 72.53-78.32)， 66.73%为肝硬化(95% CI 43.93-83.96)。肿瘤平均大小为5.50 cm (95% CI 4.71 ~ 6.29)，多发肿瘤16.01% (95% CI 10.74 ~ 23.19)。非老年和老年患者的1年(86.02%比86.66%，p=0.84)和5年OS(51.60%比53.78%)相似。同样，非老年和老年患者的1年(67.32%比73.26%，p=0.11)和5年RFS(31.57%比30.25%，p=0.67)也无差异。老年患者的轻微并发症发生率高于非老年患者(21.95%比13.71%，p=0.03)，但主要并发症发生率无差异(p=0.43)。结论:老年患者与非老年患者HCC肝切除术后的总生存率、复发率和主要并发症具有可比性，可为老年人群HCC的临床管理提供参考。
期刊介绍：
Each issue of this journal is dedicated to a special topic of current interest, covering both clinical and basic science topics in gastrointestinal function and disorders. The contents of each issue are comprehensive and reflect the state of the art, featuring editorials, reviews, mini reviews and original papers. These individual contributions encompass a variety of disciplines including all fields of gastroenterology. ''Digestive Diseases'' bridges the communication gap between advances made in the academic setting and their application in patient care. The journal is a valuable service for clinicians, specialists and physicians-in-training.
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