Effect of age on survival in patients undergoing resection of hepatocellular carcinoma

Abstract

Background: The benefit of surgical intervention for cancer should be estimated in relation to the life expectancy of the general population. The aim of this study was to provide a measure of relative survival after hepatectomy for hepatocellular carcinoma (HCC).Methods: Consecutive patients with liver cirrhosis and HCC who underwent hepatectomy were divided into age quartiles for analysis. Short-and mid-term survival rates were used to estimate survival until death for all patients, in relation to age and other co-variables. Years of life lost (YLL) were estimated using a reference cohort, derived from the general population matched for sex, age and year of diagnosis.Results: Some 919 patients were included in the study. The following age quartiles were identified: less than 60 years (229 patients), 60-66 years (230), 67-70 years (231) and over 70 years (229). Postoperative mortality rates were similar between age quartiles, as were survival rates up to 3 years (P = 0⋅404). A statistically significant reduction in 5-10-year survival rates was observed with ageing (P = 0⋅001). Relative survival calculation showed that the youngest age quartile (less than 60 years) experienced the longest entire postoperative lifespan (15⋅6 years) but also the greatest number of YLL (11⋅0 years). Patients aged over 70 years had the shortest entire postoperative lifespan (6⋅4 years) but also the smallest number of YLL (3⋅7 years).Conclusion: Although survival after liver resection for HCC is shortest in elderly patients, relative survival estimates suggest that hepatectomy can be of benefit in these patients, with a small loss of the entire individual lifespan.

The impact of age and ageing on hepatocarcinoma surgery: Short‐ and long‐term outcomes in a multicentre propensity‐matched cohort

“…For a more comprehensive interpretation of the potential benefit of surgery on elderly patients survival, we compared the life expectancy of the normal Italian population with our cohort of HCCbearing patients who underwent an operation with radical intent, as recently suggested by others. 46 The years of potential life lost (PYLL) estimates how many median years a person had lost since his premature death because of cancer, 23 Several study limitations should be acknowledged. Given the retrospective nature of the study, the major bias of our study is the impossibility to retrace "a posteriori" patient selection criteria.…”

Squaring the circle of selection and allocation in liver transplantation for HCC: An adaptive approach

“…Following the same line of reasoning, a variable age threshold beyond which the net benefit for HCC patients does not justify LT over resection or ablation seems questionable, at least until a transplantation‐ versus nontransplantation‐related benefit comparison is adjusted on reference cohorts derived from the general population matched by sex, age, and years of diagnosis. It is worth noting that within the context of patient benefit, both the absolute number of years of life gained and years of life lost with respect to life span (i.e., relative survival) should be considered when assessing the efficacy of surgical therapies offered to older patients …”

“…It is worth noting that within the context of patient benefit, both the absolute number of years of life gained and years of life lost with respect to life span (i.e., relative survival) should be considered when assessing the efficacy of surgical therapies offered to older patients. (37) Conversely, a more realistic wait time and priority score based on assumptions shown in Table 2 could silence both the utilitarian and urgency aims while including patients and societal perspectives-a process that seems essential to improve the flexibility of the transplantation system in HCC with respect to noncancer indications.…”

Liver resection associated with better outcomes for single large hepatocellular carcinoma located in the same section

“…[30–32] Furthermore, some studies showed that the elderly patients with HCC possibly had a better OS and/or RFS than that of the younger patients. [33,34] Our modeling also identified the age of < 60 years as an independent predictor of poor long-term survival.…”