Optimal treatment strategy for elderly patients with hepatocellular carcinoma
Optimal treatment strategy for elderly patients with hepatocellular carcinoma
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DOI：
10.1111/j.1440-1746.2003.03306.x
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发表时间：
2004-08-01
影响因子：
4.1
通讯作者：
Ishibashi, H
中科院分区：
文献类型：
--
作者：
Dohmen, K;Shirahama, M;Ishibashi, H
背景和目标：在日本，肝细胞癌（HCC）患者的年龄分布在近70岁时达到峰值，并且这一年龄分布还在不断增加。对于80岁或以上的老年HCC患者是否应该接受治疗，如果是，如何选择他们进行治疗仍然不确定。本研究旨在确定80岁以上和80岁以下HCC患者的临床特征和预后特征是否存在差异。方法：1989年1月至2000年12月的12年间，704例HCC患者被分为以下两组：（i）36例年龄在80岁或以上的HCC患者被定义为老年组;（ii）668名年龄在80岁以下的病人被安排在非老年组。结果：两组患者在性别、病毒标志物、血清甲胎蛋白浓度、肿瘤直径、肿瘤数目、Child分级、门静脉血栓形成、HCC组织学分级及治疗方式等方面均无显著性差异。老年组的1年和3年生存率（分别为54.1%和28.1%）与非老年组（分别为69.9%和43.2%; P = 0.1053）无显著差异。在老年组中，唯一有意义的预后因素是门静脉血栓形成，尽管Child分级为B或C几乎是一个有意义的因素，P值为0.063。肿瘤大小测量超过3厘米的最大尺寸，非孤立性肿瘤，儿童的B或C级，并存在门静脉血栓形成的预后因素，在非老年组使用多变量analysis.Conclusions：晚期肝癌，而不是先进的年龄，影响这些老年患者的生存率。因此，最佳的治疗策略应适用于老年肝癌患者谁表现出较少的预后因素，以同样的方式为非老年患者。(C)2004年Blackwell Publishing Asia Pty Ltd.
Background and Aims: The age distribution of patients with hepatocellular carcinoma (HCC) now peaks at nearly 70 years in Japan and this is continually increasing. Whether such elderly patients with HCC aged 80 years or older should be treated, and if so, how they should be selected for treatment remains uncertain. The present study was undertaken to determine any differences in the clinical characteristics and prognostic features between patients with HCC aged 80 years or older and those younger than 80 years of age. We also aimed to identify any significant variables in the prognosis of elderly patients with HCC aged 80 years or older.Methods: Seven hundred and four patients with HCC, diagnosed during a 12-year period from January 1989 to December 2000, were categorized into two groups as follows: (i) 36 patients aged 80 years or older at the detection of HCC were defined as the elderly group and; (ii) 668 patients younger than 80 years of age were placed in the non-elderly group. Clinical variables were analyzed and compared between the two groups, and any significant variables in the prognosis were simultaneously determined.Results: Regarding sex, viral markers, concentration of serum alpha-fetoprotein, diameter and number of tumors, Child's grade, presence of portal thrombosis, histology grade of HCC and any types of treatment, no significant difference was found between the two groups. The 1-year and 3-year survival rates in the elderly group (54.1 and 28.1%, respectively) were not significantly different from those in the non-elderly group (69.9 and 43.2%, respectively; P = 0.1053). The only significant factor in the prognosis in the elderly group was the presence of portal thrombosis, although a Child's grade of B or C was almost a significant factor with a P-value of 0.063. Tumor size measuring more than 3 cm in the greatest dimension, non-solitary tumor, Child's grade of B or C, and the presence of portal thrombosis were all found to be prognostic factors in the non-elderly group using a multivariate analysis.Conclusions: An advanced stage of HCC, not advanced age, influenced the survival rate in these elderly patients. Therefore, an optimal treatment strategy should be applied for elderly patients with HCC who demonstrate less prognostic factors in the same manner as that for non-elderly patients. (C) 2004 Blackwell Publishing Asia Pty Ltd.