Posttransplant Outcomes in Older Patients With Hepatocellular Carcinoma Are Driven by Non-Hepatocellular Carcinoma Factors.
Posttransplant Outcomes in Older Patients With Hepatocellular Carcinoma Are Driven by Non-Hepatocellular Carcinoma Factors.
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DOI：
10.1002/lt.25974
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Dhanasekaran R
中科院分区：
文献类型：
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作者：
Adeniji N;Arjunan V;Prabhakar V;Mannalithara A;Ghaziani T;Ahmed A;Kwo P;Nguyen M;Melcher ML;Busuttil RW;Florman SS;Haydel B;Ruiz RM;Klintmalm GB;Lee DD;Burcin Taner C;Hoteit MA;Verna EC;Halazun KJ;Tevar AD;Humar A;Chapman WC;Vachharajani N;Aucejo F;Nydam TL;Markmann JF;Mobley C;Ghobrial M;Langnas AN;Carney CA;Berumen J;Schnickel GT;Sudan DL;Hong JC;Rana A;Jones CM;Fishbein TM;Agopian V;Dhanasekaran R
肝细胞癌（HCC）的发病率在美国正在增长，特别是在老年人中。越来越多的老年患者接受肝细胞癌移植，但年龄增长对移植后长期结果的影响尚不清楚。为了研究这一点，我们使用了来自美国多中心肝癌移植联盟（UMHTC）的4980例患者的数据。我们根据移植时的年龄将患者分为4组- 18-64岁（n = 4001），65-69岁（n = 683），70-74岁（n = 252）和≥ 75岁（n = 44）。两组之间在HCC肿瘤分期、桥接局部治疗类型或移植物残留肿瘤方面没有差异。在多变量分析中，即使调整了人口统计学、病因学和癌症相关因素，高龄也被证实是总生存率的一个独立和重要的预测因素。观察到年龄对生存率的剂量反应效应，50岁以上年龄每增加5岁，死亡率绝对增加8.3%。竞争风险分析显示，老年患者非HCC相关死亡率较高（p = 0.004），而非HCC相关死亡（p = 0.24）。为了描述死亡的确切原因，我们进一步分析了一个单中心队列的肝细胞癌移植患者（n = 302）。年龄大于65岁的患者移植后新发癌症的发生率较高（18.1% vs 7.6%，p = 0.006），总体癌症相关死亡率较高（14.3% vs 6.6%，p = 0.03）。即使是精心挑选的老年HCC患者，移植后生存率也明显较差，这主要是由非HCC相关原因引起的。最大限度地减少免疫抑制和对原发性癌症的密切监测可能会改善老年肝癌移植患者的预后。
The incidence of hepatocellular carcinoma (HCC) is growing in the US, especially among the elderly. Older patients are increasingly getting transplanted for HCC, but the impact of advancing age on long-term post-transplant outcomes is not clear. To study this, we used data from the US Multicenter HCC Transplant Consortium (UMHTC) of 4980 patients. We divided the patients into 4 groups by age at transplantation- 18–64 (n = 4001), 65–69 (n = 683), 70–74 (n = 252) and ≥ 75 years (n = 44). There were no differences in HCC tumor stage, type of bridging locoregional therapy or explant residual tumor between the groups. Older age was confirmed to be an independent and significant predictor of overall survival even after adjusting for demographic, etiologic and cancer-related factors on multivariable analysis. A dose-response effect of age on survival was observed, with every 5-year increase in age over 50 years resulting in an absolute increase of 8.3% in the mortality rate. Competing risk analysis revealed that older patients experienced higher rates of non-HCC-related mortality (p = 0.004), and not HCC-related death (p = 0.24). To delineate the precise cause of death, we further analyzed a single-center cohort of patients transplanted for HCC (n = 302). Patients older than 65 years had a higher incidence of de-novo cancer (18.1% vs 7.6%, p = 0.006) after transplantation and higher overall cancer-related mortality (14.3% vs 6.6%, p = 0.03). Even carefully selected elderly patients with HCC have significantly worse post-transplant survival, which are mostly driven by non-HCC related causes. Minimizing immunosuppression and closer surveillance for de novo cancers can potentially improve outcomes in elderly patients transplanted for HCC.
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DOI：
10.1136/bmj.g6679
发表时间：
2014-11-24
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Knoll GA;Kokolo MB;Mallick R;Beck A;Buenaventura CD;Ducharme R;Barsoum R;Bernasconi C;Blydt-Hansen TD;Ekberg H;Felipe CR;Firth J;Gallon L;Gelens M;Glotz D;Gossmann J;Guba M;Morsy AA;Salgo R;Scheuermann EH;Tedesco-Silva H;Vitko S;Watson C;Fergusson DA
通讯作者：
Fergusson DA
影响因子：
4.6
作者：
Schwartz, Jason J.;Pappas, Lisa;Box, Terry
通讯作者：
Box, Terry
影响因子：
6.2
作者：
Krenzien F;ElKhal A;Quante M;Rodriguez Cetina Biefer H;Hirofumi U;Gabardi S;Tullius SG
通讯作者：
Tullius SG
影响因子：
0.9
作者：
Diedrich, D. A.;Findlay, J. Y.;Rosen, C. B.
通讯作者：
Rosen, C. B.
影响因子：
4.8
作者：
Scrucca, L.;Santucci, A.;Aversa, F.
通讯作者：
Aversa, F.