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

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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 diseasefree 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.

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 diseasefree 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.

참고문헌 (77)

  1. Rumgay H, "Global burden of primary liver cancer in 2020 and predictions to 2040", J Hepatol, 77, pp.1598~1606 (2022)
  2. Zhang CH, "Changing epidemiology of hepatocellular carcinoma in Asia", Liver Int, 42, pp.2029~2041 (2022)
  3. Nishikawa H, "Treatment for hepatocellular carcinoma in elderly patients : a literature review", J Cancer, 4, pp.635~643 (2013)
  4. Jang W, "Clinical characteristics and prognosis of Korean patients with hepatocellular carcinoma with respect to etiology", J Liver Cancer, 22, pp.158~166 (2022)
  5. Korean Liver Cancer Association(KLCA)and National Cancer Center(NCC)Korea, "2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma", J Liver Cancer, 23, pp.1~120 (2023)
  6. Shin SW, "Liver resection versus local ablation therapies for hepatocellular carcinoma within the Milan criteria : a systematic review and meta-analysis", Ann Surg, 273, pp.656~666 (2021)
  7. Lee HA, "Change in the recurrence pattern and predictors over time after complete cure of hepatocellular carcinoma", Gut Liver, 15, pp.420~429 (2021)
  8. Devalapalli AP, "Perioperative care of geriatric patients", Hosp Pract(1995), 48(sup1), pp.26~36 (2020)
  9. Jang JY, "Stereotactic body radiation therapy for elderly patients with small hepatocellular carcinoma : a retrospective observational study", J Liver Cancer, 22, pp.136~145 (2022)
  10. Jo SJ, "Indications for open hepatectomy in the era of laparoscopic liver resection : a high volume single institutional study", J Liver Cancer, 22, pp.146~157 (2022)
  11. Harada M, "Impact of patient age on outcome after resection for hepatocellular carcinoma", Biosci Trends, 15, pp.33~40 (2021)
  12. Fujio A, "Usefulness of preoperative controlling nutritional status in predicting prolonged hospitalization and incidence of postoperative delirium for elderly hepatectomy with hepatocellular carcinoma", Tohoku J Exp Med, 256, pp.43~52 (2022)
  13. Chen ZL, "Major hepatectomy in elderly patients with large hepatocellular carcinoma : a multicenter retrospective observational study", Cancer Manag Res, 12, pp.5607~5618 (2020)
  14. Slim K, "Methodological index for non-randomized studies(MINORS) : development and validation of a new instrument", ANZ J Surg, 73, pp.712~716 (2003)
  15. Pu JL, "Long-term oncological prognosis after curative-intent liver resection for hepatocellular carcinoma in the young versus the elderly : multicentre propensity score-matching study", BJS Open, 6, pp.zrab145~ (2022)
  16. Liu YW, "Liver resection in elderly patients with hepatocellular carcinoma : age does matter", Updates Surg, 73, pp.1371~1380 (2021)
  17. Tan LL, "Effect of age on the shortand long-term outcomes of patients undergoing curative liver resection for HCC", Eur J Surg Oncol, 48, pp.1339~1347 (2022)
  18. Shin IS, "Hepatocellular carcinoma in old age : are there any benefits of liver resection in old age?", Ann Surg Treat Res, 99, pp.65~71 (2020)
  19. Shimada S, "Prognoses, outcomes, and clinicopathological characteristics of very elderly patients with hepatocellular carcinoma who underwent hepatectomy", World J Surg Oncol, 18, pp.122~ (2020)
  20. Yasuda S, "Liver regeneration after major liver resection for hepatocellular carcinoma in the elderly", J Invest Surg, 33, pp.332~338 (2020)
  21. Xing H, "Multicenter analysis of longterm oncologic outcomes of hepatectomy for elderly patients with hepatocellular carcinoma", HPB(Oxford), 22, pp.1314~1323 (2020)
  22. Famularo S, "The impact of age and ageing on hepatocarcinoma surgery : short-and longterm outcomes in a multicentre propensity-matched cohort", Liver Int, 39, pp.894~904 (2019)
  23. Jiang YQ, "Efficacy of hepatic resection vs. radiofrequency ablation for patients with very-early-stage or early-stage hepatocellular carcinoma : a population-based study with stratification by age and tumor size", Front Oncol, 9, pp.113~ (2019)
  24. Kaibori M, "Impact of advanced age on survival in patients undergoing resection of hepatocellular carcinoma : report of a Japanese nationwide survey", Ann Surg, 269, pp.692~699 (2019)
  25. Okamura Y, "The short-and long-term outcomes in elderly patients with hepatocellular carcinoma after curative surgery : a casecontrolled study with propensity score matching", Eur Surg Res, 59, pp.380~390 (2018)
  26. Chen Y, "Feasibility of hepatectomy in elderly patients with hepatocellular carcinoma", Int J Clin Exp Med, 11, pp.7038~7046 (2018)
  27. Goh BK, "Perioperative outcomes of laparoscopic minor hepatectomy for hepatocellular carcinoma in the elderly", World J Surg, 42, pp.4063~4069 (2018)
  28. Hsu KF, "Long-term outcomes in elderly patients with resectable large hepatocellular carcinoma undergoing hepatectomy", Surg Oncol, 27, pp.595~601 (2018)
  29. Wang W, "Shortand long-term outcomes of laparoscopic hepatectomy in elderly patients with hepatocellular carcinoma", J BUON, 23, pp.971~978 (2018)
  30. Yu X, "The efficacy and safety of totally laparoscopic hepatectomy for non-cirrhotic hepatocellular carcinoma in the elderly", BMC Surg, 18, pp.118~ (2018)
  31. Santambrogio R, "Effect of age(over 75 years)on postoperative complications and survival in patients undergoing hepatic resection for hepatocellular carcinoma", J Gastrointest Surg, 21, pp.657~665 (2017)
  32. Bauschke A, "Partial liver resection results in a significantly better long-term survival than locally ablative procedures even in elderly patients", J Cancer Res Clin Oncol, 142, pp.1099~1108 (2016)
  33. Cucchetti A, "Effect of age on survival in patients undergoing resection of hepatocellular carcinoma", Br J Surg, 103, pp.e93~e99 (2016)
  34. Harimoto N, "Sarcopenia is a poor prognostic factor following hepatic resection in patients aged 70 years and older with hepatocellular carcinoma", Hepatol Res, 46, pp.1247~1255 (2016)
  35. Kim JM, "Hepatectomy is a reasonable option for older patients with hepatocellular carcinoma", Am J Surg, 209, pp.391~397 (2015)
  36. Kishida N, "Validation of hepatectomy for elderly patients with hepatocellular carcinoma", Ann Surg Oncol, 22, pp.3094~3101 (2015)
  37. Motoyama H, "Impact of advanced age on the short-and long-term outcomes in patients undergoing hepatectomy for hepatocellular carcinoma : a single-center analysis over a 20-year period", Am J Surg, 209, pp.733~741 (2015)
  38. Nozawa A, "Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80years and older in the first decade of the 21st century", Surg Today, 45, pp.851~857 (2015)
  39. Sato S, "Hepatic resection for hepatocellular carcinoma in the elderly : selecting hepatectomy procedures based on patient age", Anticancer Res, 35, pp.6855~6860 (2015)
  40. Faber W, "Significant impact of patient age on outcome after liver resection for HCC in cirrhosis", Eur J Surg Oncol, 40, pp.208~213 (2014)
  41. Liu PH, "Uncompromised treatment efficacy in elderly patients with hepatocellular carcinoma : a propensity score analysis", Medicine(Baltimore), 93, pp.e264~ (2014)
  42. Mori S, "Outcome of hepatectomy for hepatocellular carcinoma in elderly patients with portal hypertension", Int Surg, 99, pp.153~160 (2014)
  43. Ueno M, "Recent trends in hepatectomy for elderly patients with hepatocellular carcinoma", Surg Today, 44, pp.1651~1659 (2014)
  44. Wang HQ, "Liver resection in hepatitis B related-hepatocellular carcinoma : clinical outcomes and safety in elderly patients", World J Gastroenterol, 20, pp.6620~6625 (2014)
  45. Wang WL, "Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis", Eur J Gastroenterol Hepatol, 26, pp.444~451 (2014)
  46. Hirokawa F, "Surgical outcomes and clinical characteristics of elderly patients undergoing curative hepatectomy for hepatocellular carcinoma", J Gastrointest Surg, 17, pp.1929~1937 (2013)
  47. Ide T, "Prediction of postoperative complications in elderly patients with hepatocellular carcinoma", J Surg Res, 185, pp.614~619 (2013)
  48. Murillo A, "Hepatic resection in hepatocarcinoma : a comparative study between patients under and over 70 years-old", Cir Esp, 91, pp.224~230 (2013)
  49. Nishikawa H, "Surgical resection for hepatocellular carcinoma : clinical outcomes and safety in elderly patients", Eur J Gastroenterol Hepatol, 25, pp.912~919 (2013)
  50. Taniai N, "Surgical outcomes and prognostic factors in elderly patients(75years or older)with hepatocellular carcinoma who underwent hepatectomy", J Nippon Med Sch, 80, pp.426~432 (2013)
  51. Lee CR, "A comparative analysis of hepatocellular carcinoma after hepatic resection in young versus elderly patients", J Gastrointest Surg, 16, pp.1736~1743 (2012)
  52. Nanashima A, "Prognosis of patients with hepatocellular carcinoma after hepatic resection : are elderly patients suitable for surgery?", J Surg Oncol, 104, pp.284~291 (2011)
  53. Portolani N, "Limited liver resection : a good indication for the treatment of hepatocellular carcinoma in elderly patients", Jpn J Clin Oncol, 41, pp.1358~1365 (2011)
  54. Mirici-Cappa F, "Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients : a 20-year multicentre experience", Gut, 59, pp.387~396 (2010)
  55. Sanyal S, "Outcomes of liver resection for hepatocellular carcinoma in octogenarians", HPB(Oxford), 22, pp.1324~1329 (2020)
  56. Inoue Y, "Surgical outcome and hepatic regeneration after hepatic resection for hepatocellular carcinoma in elderly patients", Dig Surg, 36, pp.289~301 (2019)
  57. Lee CW, "Hepatic resection for hepatocellular carcinoma in the octogenarian : is it justified?", Aging(Albany NY), 11, pp.1537~1550 (2019)
  58. Wu FH, "Liver resection for hepatocellular carcinoma in oldest old patients", World J Surg Oncol, 17, pp.1~ (2019)
  59. Hamaoka M, "Evaluation of the risk factors and prognostic factors of hepatectomy for hepatocellular carcinoma in patients aged 80 years or more", J Hepatobiliary Pancreat Sci, 24, pp.58~64 (2017)
  60. Katsuta E, "Age-related clinicopathologic and molecular features of patients receiving curative hepatectomy for hepatocellular carcinoma", Am J Surg, 208, pp.450~456 (2014)
  61. Tsujita E, "Outcome of hepatectomy in hepatocellular carcinoma patients aged 80years and older", Hepatogastroenterology, 59, pp.1553~1555 (2012)
  62. Yamada S, "Outcome of hepatectomy in super-elderly patients with hepatocellular carcinoma", Hepatol Res, 42, pp.454~458 (2012)
  63. Lurje G, "Prognostic factors of disease-free and overall survival in patients with hepatocellular carcinoma undergoing partial hepatectomy in curative intent", Langenbecks Arch Surg, 403, pp.851~861 (2018)
  64. Lee HA, "The efficacy of treatment for hepatocellular carcinoma in elderly patients", J Liver Cancer, 23, pp.362~376 (2023)
  65. Nishikawa H, "Radiofrequency ablation for hepatocellular carcinoma", Int J Hyperthermia, 29, pp.558~568 (2013)
  66. Gunasekaran G, "Surgical treatments of hepatobiliary cancers", Hepatology, 73(Suppl 1), pp.128~136 (2021)
  67. Younossi ZM, "The global burden of liver disease", Clin Gastroenterol Hepatol, 21, pp.1978~1991 (2023)
  68. Lee VH, "Contrasting some differences in managing advanced unresectable hepatocellular carcinoma between the east and the west", Clin Oncol(R Coll Radiol), 31, pp.560~569 (2019)
  69. Choo SP, "Comparison of hepatocellular carcinoma in Eastern versus Western populations", Cancer, 122, pp.3430~3446 (2016)
  70. Huang DQ, "Global epidemiology of NAFLD-related HCC : trends, predictions, risk factors and prevention", Nat Rev Gastroenterol Hepatol, 18, pp.223~238 (2021)
  71. Younossi ZM, "Association of nonalcoholic fatty liver disease(NAFLD)with hepatocellular carcinoma(HCC)in the United States from 2004 to 2009", Hepatology, 62, pp.1723~1730 (2015)
  72. Lin BZ, "Differentiation of clinical patterns and survival outcomes of hepatocellular carcinoma on hepatitis B and nonalcoholic fatty liver disease", J Chin Med Assoc, 84, pp.606~613 (2021)
  73. Llovet JM, "Hepatocellular carcinoma", Nat Rev Dis Primers, 7, pp.6~ (2021)
  74. Elfrink AK, "Short-term postoperative outcomes after liver resection in the elderly patient : a nationwide population-based study", HPB(Oxford), 23, pp.1506~1517 (2021)
  75. Chen Y, "Laparoscopic versus open hepatectomy for elderly patients with hepatocellular carcinoma", J BUON, 25, pp.1404~1412 (2020)
  76. Teng PC, "Diabetes and risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease", Gut Liver, 17, pp.24~33 (2023)
  77. Shin SK, "Partial virological response after 2 years of entecavir therapy increases the risk of hepatocellular carcinoma in patients with hepatitis B virusassociated cirrhosis", Gut Liver, 15, pp.430~439 (2021)

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