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1
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Abdelmoneim RS, Sedki F, Bakosh MF. Changes in the presentation and characteristics OF HCV related hepatocellular carcinoma in the era of direct acting antiviral therapy: A retrospective study. Clin Res Hepatol Gastroenterol 2025; 49:102567. [PMID: 40043794 DOI: 10.1016/j.clinre.2025.102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 02/19/2025] [Accepted: 03/02/2025] [Indexed: 03/10/2025]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the sixth common malignancy worldwide. In Egypt, the main cause of HCC is hepatitis C virus (HCV)-related cirrhosis. After the successful mass treatment program of HCV in 2018 with direct-acting antivirals (DAAs) therapy, a large percentage of patients have been treated and effectively achieved sustained virological response (SVR). Recently, some studies claimed that HCCs that developed after treatment with DAAs have more aggressive behavior. Purpose of the study is to detect the possible change of HCC pattern before and after DAAs era and its effect on overall survival (OS). METHODS 428 naïve HCC patients were divided into 2 groups: Group I HCC patients not treated with DAAs and Group II HCC patients treated with DAAs. Then we compared demographic, clinical, radiological, and laboratory characteristics between both groups. RESULTS Group II had improved liver function tests, including serum bilirubin, albumin, and international normalized ratio, than Group I (p < 0.001, p < 0.001, p < 0.001, respectively). They had a lower level of liver aminotransferases. Group II showed a larger infiltrative pattern of HCC, with a high incidence of portal vein thrombosis (p = 0.003, p < 0.001, p = 0.048, respectively). Group II received more curative or palliative treatment options, while 55 % of Group I received the best supportive care. There was no significant difference in 1-year and 2-years OS between both group, except that group II patients had better 2-year OS in subgroup BCLC stage C. CONCLUSION The tumor pattern has changed into a more aggressive phenotype after DAAs. DAAs have succeeded in preserving the liver condition. However, they did not demonstrate any protective effect on the OS of the patients. There is a strong need for strict screening program for early detection of HCC in the early stages, that are eligible for curative options, after HCV treatment of DAAs.
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Affiliation(s)
- Randa Salah Abdelmoneim
- Hepato-pancreatico-biliary Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
| | - Fathalla Sedki
- Hepato-pancreatico-biliary Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
| | - Mohamed Fathy Bakosh
- Hepato-pancreatico-biliary Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
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Shehta A, Medhat M, Farouk A, Monier A, Said R, Salah T, Fouad A, Ali MA. Liver resection for hepatocellular carcinoma in elderly patients: does age matter? BMC Surg 2024; 24:248. [PMID: 39237941 PMCID: PMC11376034 DOI: 10.1186/s12893-024-02528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 08/08/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Evaluation of the influence of the age of the patients upon the outcomes of liver resection (LR) for hepatocellular carcinoma (HCC). METHODS HCC patients who underwent LR between 2010 and 2020 were analyzed. They were divided into 3 groups depending on the patient's age. Group I (patients less than 60 years), Group II (patients between 60 and 69 years), and Group III (patients equal to or more than 70 years). RESULTS 364 patients were included. A significantly higher serum bilirubin and alpha feto-protein were noted in Group I and serum creatinine was noted in Group III. The study groups did not show any significant differences regarding HCC site, number, macrovascular invasion, the extent of LR, Pringle maneuver, and perioperative blood transfusions. Longer operation time was found in Groups II and III, while more blood loss was noted in Group (I) Group I patients had longer hospital stays. Higher postoperative morbidities were noted in both Group I and Group (II) Higher incidence of post-hepatectomy liver dysfunction was noted in Group I. More early mortalities were found in Group I, related to liver failure. We did not experience early mortality in Group (III) Late Mortalities occurred in 117 patients (32.1%). HCC recurrence occurred in 165 patients (45.3%). Regarding the overall- and tumor-free survival, we did not experience any significant differences among the 3 groups (Log Rank: p = 0.371 and 0.464 respectively). CONCLUSIONS Curative LR can be safely performed in selected elderly patients with HCC. An advanced patient's age should not be considered as a contraindication for curative LR.
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Affiliation(s)
- Ahmed Shehta
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt.
- Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt.
| | - Mohamed Medhat
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
| | - Ahmed Farouk
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
| | - Ahmed Monier
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
| | - Rami Said
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
| | - Tarek Salah
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
| | - Amgad Fouad
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
| | - Mahmoud Abdelwahab Ali
- Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt
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Chen YS, Hsieh PM, Lin HY, Hung CM, Lo GH, Hsu YC, Lu IC, Lee CY, Wu TC, Yeh JH, Hsiao P, Li YC, Wang YC, Hsieh KC, Lin CW. Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis. BMC Gastroenterol 2021; 21:220. [PMID: 33990184 PMCID: PMC8120780 DOI: 10.1186/s12876-021-01807-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.
Methods Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed. Results
In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0–96) months for the total cohort and was subdivided into 52 (8–96), 32 (1–96), 19 (0–84), and 12 (0–79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were (1) SR and cirrhosis; (2) SR, cirrhosis, and Child–Pugh (C–P) class; (3) SR, hepatitis B virus (HBV) infection, and C–P class; and (4) SR, HBV infection, and C–P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs. non-SR were 44.0% versus 28.7%, 72.2% versus 42.6%, 42.6% versus 36.2, 44.6% versus 23.5%, and 41.4% versus 15.3% (all P values < 0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages. Conclusions SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01807-4.
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Affiliation(s)
- Yaw-Sen Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Pei-Min Hsieh
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Hung-Yu Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Chao-Ming Hung
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Gin-Ho Lo
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - I-Cheng Lu
- Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Chih-Yuan Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan, ROC
| | - Tsung-Chin Wu
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC.,Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Pojen Hsiao
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Yu-Chan Li
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Ya-Chin Wang
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Kun-Chou Hsieh
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC. .,Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC. .,Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC. .,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC. .,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan, ROC. .,Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan, ROC.
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Zhang X, El-Serag HB, Thrift AP. Predictors of five-year survival among patients with hepatocellular carcinoma in the United States: an analysis of SEER-Medicare. Cancer Causes Control 2021; 32:317-325. [PMID: 33394207 DOI: 10.1007/s10552-020-01386-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most patients with hepatocellular carcinoma (HCC) are ≥ 65 years old at diagnosis and ~ 20% present with disease amenable to curative intent surgical therapy. The aim of this study was to examine whether treatment, the demographic variables, and clinical factors could predict 5-year survival among HCC patients. METHODS We included patients, 66 years or older, diagnosed with a first primary HCC from 1994 through 2007 in the SEER-Medicare database, and followed up until death or 31 December 2012. Curative intent treatment was defined as liver transplantation, surgery resection, or ablation. We estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with 5-year survival using logistic regression. RESULTS We identified 10,826 patients with HCC with mean age 75.3 (standard deviation, 6.4) years. Most were male (62.2%) and non-Hispanic white (59.7%). Overall, only 8.1% of patients were alive 5 years post-HCC diagnosis date. Among all patients that survived ≥ 5 years, 69.8% received potentially curative treatment. Conversely, patients who received potentially curative treatment represented only 15.7% of patients who survived < 5 years. Curative intent treatment was the strongest predictor for surviving ≥ 5 years (vs. none/palliative treatment; adjusted OR 8.12, 95% CI 6.90-9.64). While stage at diagnosis and comorbidities were also independently associated with ≥ 5-year survival in HCC patients, these factors did not improve discrimination between short- and long-term survivors. CONCLUSIONS Curative intent treatment was the strongest predictor for survival ≥ 5 years among HCC patients. Given the limited availability of liver transplant and limited eligibility for surgical resection, finding curative intent HCC therapies remain critically important.
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Affiliation(s)
- Xiaotao Zhang
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. .,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA. .,Baylor College of Medicine, One Baylor Plaza, MS: BCM307, Room 613D, Houston, TX, 77030-3498, USA.
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
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5
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Tsuchiya K, Ohki T, Sato K, Kondo M, Toda N, Tagawa K. Efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma treatment in patients aged ≥80 years. LIVER RESEARCH 2020. [DOI: 10.1016/j.livres.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Mosconi C, Gramenzi A, Biselli M, Cappelli A, Bruno A, De Benedittis C, Cucchetti A, Modestino F, Peta G, Bianchi G, Trevisani F, Golfieri R. Survival and Tolerability of Transarterial Chemoembolization in Greater Versus less than 70 Years of Age Patients with Unresectable Hepatocellular Carcinoma: A Propensity Score Analysis. Cardiovasc Intervent Radiol 2020; 43:1015-1024. [PMID: 32236670 DOI: 10.1007/s00270-020-02451-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/11/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is progressively increasing. The aim of this study was to determine the safety and efficacy of conventional transarterial chemoembolization (TACE) in elderly HCC patients compared with younger adults. METHODS A consecutive cohort of unresectable HCC patients treated with TACE as a first-line treatment was retrospectively analyzed. Patients were categorized into "elderly" (≥ 70 years, 80 patients) and "younger" (< 70 years, 145 patients). Liver-related death and progression-free survival after TACE were compared before and after propensity score matching. A competing risk regression analysis was used for univariate/multivariate survival data analysis. RESULTS cTACE was well tolerated in both groups. The cumulative risk of both liver-related death and progression-free survival after cTACE was comparable between "elderly" and "younger" (death: 73.8% vs 69.4%, P = 0.505; progression-free survival: 48.2% vs 44.8%, P = 0.0668). Propensity model matched 61 patients in each group for gender and Barcelona Clinic Liver Cancer staging. Even after matching, the cumulative risk of liver-related death and of progression-free survival did not differ between the two groups. At multivariate analysis, Child-Pugh class, tumor gross pathology and alpha-fetoprotein were independently associated with the liver-related mortality risk. CONCLUSIONS This study confirms that TACE is well tolerated and effective in patients aged 70 years or more with unresectable HCC as it is for their younger counterparts (< 70 years). Liver-related mortality was not associated with age ≥ 70 years and primarily predicted by tumor multifocality, Child-Pugh class B and an increased alpha-fetoprotein value (> 31 ng/ml).
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Affiliation(s)
- Cristina Mosconi
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Annagiulia Gramenzi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Maurizio Biselli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Alberta Cappelli
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Bruno
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Caterina De Benedittis
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, Italy
| | - Francesco Modestino
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuliano Peta
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Rita Golfieri
- Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Sarveazad A, Agah S, Babahajian A, Amini N, Bahardoust M. Predictors of 5 year survival rate in hepatocellular carcinoma patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:86. [PMID: 31741658 PMCID: PMC6856560 DOI: 10.4103/jrms.jrms_1017_18] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/25/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022]
Abstract
Background Hepatocellular carcinoma (HCC) is one of the most common primary hepatic malignancies and growing challenges of global health. In this study, for the first time in Iran, we investigated the 5-year survival rate and prognostic factors in patients with HCC. Materials and Methods In this historical cohort study, we examined the medical records of 227 HCC patients who were registered in the central tumor registry of our institution from September 2007 to September 2017. Demographic data, clinical parameters, received treatments, and survival curves from time of diagnosis were evaluated. Kaplan-Meier was used for univariate analysis, and multivariable analysis was performed by Cox regression. Results A total of 208 (91.63%) patients were dead. The 5-year survival rate was estimated 19 (8.37%). The average follow-up in this study was 14.3 months. Overall median survival rate was 12.1 months. Univariate analysis showed that tumor size, metastasis, number of involved lymph node, hepatitis type, and treatment were significantly related to the survival rate, and Cox regression analysis revealed that the tumor size >3 cm (hazard ratio [HR] = 3.06, 95% confidence interval [CI] = 1.68-4.97; P = 0.027), involved lymph nodes >2 (HR = 4.12, 95% CI = 2.66-6.38; P = 0.001), metastasis (HR = 3.87, 95% CI = 3.13-6.54; P = 0.011), combination therapy with surgery and chemotherapy (HR = 0.4, 95% CI = 0.15-0.79; P = 0.023), and coinfection with hepatitis B virus and hepatitis C virus (HR = 2.11, 95% CI = 1.81-4.6; P = 0.036) are the most relevant prognostic factors with 5-year survival rate in patients with HCC. Conclusion Results of this study will help estimate survival rates for patients with HCC according to their clinical status.
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Affiliation(s)
- Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Agah
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Asrin Babahajian
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Carrier P, Debette-Gratien M, Jacques J, Loustaud-Ratti V. Cirrhotic patients and older people. World J Hepatol 2019; 11:663-677. [PMID: 31598192 PMCID: PMC6783402 DOI: 10.4254/wjh.v11.i9.663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
The global population is aging, and so the number of older cirrhotic patients is increasing. Older patients are characterised by a risk of frailty and comorbidities, and age is a risk factor for mortality in cirrhotic patients. The incidence of non-alcoholic fatty liver disease as an aetiology of cirrhosis is increasing, while that of chronic viral hepatitis is decreasing. Also, cirrhosis is frequently idiopathic. The management of portal hypertension in older cirrhotic patients is similar to that in younger patients, despite the greater risk of treatment-related adverse events of the former. The prevalence of hepatocellular carcinoma increases with age, but its treatment is unaffected. Liver transplantation is generally recommended for patients < 70 years of age. Despite the increasing prevalence of cirrhosis in older people, little data are available and few recommendations have been proposed. This review suggests that comorbidities have a considerable impact on older cirrhotic patients.
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Affiliation(s)
- Paul Carrier
- Fédération d’Hépatologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
- Faculté de Médecine et de Pharmacie de Limoges, Rue Docteur Marcland, Limoges 87042, France
| | - Marilyne Debette-Gratien
- Fédération d’Hépatologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
- Faculté de Médecine et de Pharmacie de Limoges, Rue Docteur Marcland, Limoges 87042, France
| | - Jérémie Jacques
- Service de Gastroentérologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
| | - Véronique Loustaud-Ratti
- Fédération d’Hépatologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
- Faculté de Médecine et de Pharmacie de Limoges, Rue Docteur Marcland, Limoges 87042, France.
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Zhao GS, Li C, Liu Y, Ren ZZ, Yuan XL, Zhou J, Zhang YW, Zhang M. 350-560 μm gelatin sponge particles combined with transcatheter arterial chemoembolization for the treatment of elderly hepatocellular carcinoma: The safety and efficacy. Medicine (Baltimore) 2017; 96:e6629. [PMID: 28422858 PMCID: PMC5406074 DOI: 10.1097/md.0000000000006629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To retrospectively analyze the safety and efficacy of 350-560 μm gelatin sponge particles combined with single-chemotherapy drug transcatheter arterial chemoembolization (Gs-TACE) for the treatment of elderly hepatocellular carcinoma without surgical resection.Thirty elderly hepatocellular carcinoma patients without surgical resection, who received Gs-TACE in our hospital, were selected. Slowly injected gelatin sponge particles (350-560 μm)+ 10 mg lobaplatin injection into the regional embolization tumor target vessel. The Response Evaluation Criteria for Solid Tumors could be used to evaluate the tumor response after intervention surgery.Eighty-nine times of intervention TACE were conducted on the 30 patients. The average size of tumor was 8.3 cm. The median survival time was 28 months, and the 1 and 2-year survival rates were 89% and 58%, respectively. The Response Evaluation Criteria for Solid Tumors was used to evaluate the tumor response, and found that the complete response, partial response, and OR were 30%, 56.67%, and 86.67%, respectively, at 1 month after intervention surgery. The patients were divided into groups: 60 to 65 years age group (A), >65 to 75 years age group (B), and >75 years age group (C); the median survival times were 16, 32, and 33 months, respectively, and there was statistical difference between A group, B group, and C group. The analysis of prognosis factors showed that there was statistical significance in age, Barcelona Clinic Liver Cancer stage, portal vein invasion, and alpha fetal protein (AFP), and age was the protective factor.Gelatin sponge particles (350-560 μm), combined with transcatheter arterial chemoembolization, provide an alternative method for the treatment of elderly hepatocellular carcinoma without surgical resection.
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Affiliation(s)
- Guang Sheng Zhao
- Department of Radiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province
- Department of Interventional Therapy
| | - Chuang Li
- Department of Interventional Therapy
| | - Ying Liu
- Department of Interventional Therapy
| | | | - Xiao Lin Yuan
- Central Laboratory, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province
| | - Jun Zhou
- Department of Interventional Therapy
| | - Yue Wei Zhang
- Department of Hepatobiliary Intervention, Beijing Tsinghua Changgung Hospital, Changping District, Beijing, China
| | - Ming Zhang
- Department of Radiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province
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Hamaoka M, Kobayashi T, Ishiyama K, Ohira M, Tahara H, Kuroda S, Iwako H, Okimoto S, Honmyo N, Ohdan H. Evaluation of the risk factors and prognostic factors of hepatectomy for hepatocellular carcinoma in patients aged 80 years or more. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:58-64. [DOI: 10.1002/jhbp.413] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Michinori Hamaoka
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Hiroshi Iwako
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Sho Okimoto
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Naruhiko Honmyo
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery; Applied Life Sciences; Institute of Biomedical and Health Sciences; Hiroshima University; 1-2-3 Kasumi Minami-ku Hiroshima 734-8551 Japan
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11
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Kinoshita A, Koike K, Nishino H. Clinical features and prognosis of elderly patients with hepatocellular carcinoma not indicated for surgical resection. Geriatr Gerontol Int 2016; 17:189-201. [PMID: 26847184 DOI: 10.1111/ggi.12747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 12/17/2022]
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide. The average life expectancy during the 20th century has increased in many parts of the world, and therefore the opportunities to examine elderly HCC patients have significantly increased worldwide. Many elderly patients develop HCC with intermediate to advanced stages of disease at the initial diagnosis, and have more comorbidities and compromised liver regeneration compared with younger patients. These circumstances show that elderly patients with HCC are poorer candidates for surgical resection or transplantation. The aim of the present review was to focus on the clinical features and prognosis of elderly HCC patients not indicated for surgical resection including multimodal treatment. Although the chronological age of 60 or 65 years as the definition of an elderly person is accepted in most countries, many studies in our review article define elderly as those aged 75 years or older. Geriatr Gerontol Int 2017; 17: 189-201.
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Affiliation(s)
- Akiyoshi Kinoshita
- Division of Gastroenterology and Hepatology, the Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuhiko Koike
- Division of Gastroenterology and Hepatology, the Jikei University Daisan Hospital, Tokyo, Japan
| | - Hirokazu Nishino
- Division of Gastroenterology and Hepatology, the Jikei University Daisan Hospital, Tokyo, Japan
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Su Z, Wei G, Wei L, Liu J, Li X. Effects of rhBNP on myocardial fibrosis after myocardial infarction in rats. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:6407-6415. [PMID: 26261516 PMCID: PMC4525850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE We aimed to observe the effects and mechanism of rhBNP treatment on myocardial fibrosis (MF) after myocardial infarction (MI). METHODS SPF rats were separated into 3 groups: normal, MI (ligation of left coronary artery), and MI + rhBNP (recombinant human brain natriuretic peptide). Rats in MI + rhBNP group were given 30 μg/kg for 2 days before modeling and for 4 weeks after modeling. mRNA levels and the expression levels of TGF-β1 (transforming growth factor) and CTGF (connective tissue growth factor) in 3 groups were analyzed using the RT-qPCR and western blotting analysis, respectively. Furthermore, myocardial volume fraction (CVF) was analyzed using the Sirius Red F3B (SR) while the percentage of type I and III collagen in 3 groups were analyzed using the immunohistochemical staining. RESULTS Compared with the normal group, the levels of TGF-β1, CTGF, CVF, type I and III collagen were higher in MI group. However, mRNA levels of TGF-β1 and CTGF were significantly decreased in MI + rhBNP compared to MI groups. Expression of TGF-β1 was lower while that of CTGF was higher in MI + rhBNP group than that in MI group. Besides, CVF, and type I and III collagen were lower in MI + rhBNP group compared with MI group. CONCLUSION rhBNP could significantly decrease the TGF-β1 and CTGF levels in post-MI so as to inhibit the type I and III collagen deposition in MF of post-MI. rhBNP will be benefit for the improvement of MF.
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Affiliation(s)
- Zhendong Su
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University Harbin 150001, China
| | - Guoqian Wei
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University Harbin 150001, China
| | - Li Wei
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University Harbin 150001, China
| | - Junyan Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University Harbin 150001, China
| | - Xueqi Li
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University Harbin 150001, China
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13
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Liu PH, Hsu CY, Lee YH, Hsia CY, Huang YH, Su CW, Chiou YY, Lin HC, Huo TI. Uncompromised treatment efficacy in elderly patients with hepatocellular carcinoma: a propensity score analysis. Medicine (Baltimore) 2014; 93:e264. [PMID: 25526453 PMCID: PMC4603105 DOI: 10.1097/md.0000000000000264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The number of elderly hepatocellular carcinoma (HCC) patients is expected to rise. We analyzed the impact of age on clinical presentations, treatment allocation, and long-term survival between elderly (≥75 years) and younger (<75 years) HCC patients. In this study, a total of 812 elderly and 2270 younger HCC patients were evaluated. The baseline information and long-term survival were compared in the entire population and in different treatment groups. A propensity score matching analysis with preset caliper width was utilized to compare survival differences in different patient subgroups. Elderly HCC patients had discrete characteristics compared with younger HCC patients. Elderly patients received surgical resection (SR) less frequently, while more elderly patients underwent radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). Younger patients had significantly better long-term survival than the elderly patients in all patients and in patients receiving SR (both P<0.05). However, of the entire cohort, age was not an independent predictor of poor prognosis in the Cox multivariate model. The long-term survival was similar between 2 age groups in patients receiving RFA and TACE. In the propensity model, there were no significant survival differences among patients receiving SR, RFA, or TACE (all P>0.05). Among the elderly, the Cancer of the Liver Italian Program (CLIP) score provided the lowest Akaike information criterion value. In conclusion, advanced age is not associated with inferior treatment result in HCC patients receiving different therapeutic modalities. Elderly HCC patients should be encouraged for active treatment when indicated. The CLIP is an optimal prognostic model for outcome assessment.
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Affiliation(s)
- Po-Hong Liu
- From the Faculty of Medicine (PHL, CYH, YHL, CYH, CWS, YYC, HCL, TIH); Institute of Clinical Medicine (YHH); Institute of Pharmacology (TIH), National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine (PHL, CYH, YHL, YHH, CWS, HCL, TIH); Department of Surgery (CYH); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (YYC); and Department of Biostatistics, UCLA, Los Angeles, CA, USA (CYH)
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Oishi K, Itamoto T, Kohashi T, Matsugu Y, Nakahara H, Kitamoto M. Safety of hepatectomy for elderly patients with hepatocellular carcinoma. World J Gastroenterol 2014; 20:15028-36. [PMID: 25386051 PMCID: PMC4223236 DOI: 10.3748/wjg.v20.i41.15028] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/11/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing. Characteristics of elderly HCC patients are a higher proportion of females, a lower rate of positive hepatitis B surface antigen, and a higher rate of positive hepatitis C antibodies. Careful patient selection is vital for performing hepatectomy safely in elderly HCC patients. Treatment strategy should be decided by not only considering tumor stage and hepatic functional reserve, but also physiological status, including comorbid disease. Various assessment tools have been applied to predict the risk of hepatectomy. The reported mortality and morbidity rates after hepatectomy in elderly HCC patients ranged from 0% to 42.9% and from 9% to 51%, respectively. Overall survival rate after hepatectomy in elderly HCC patients at 5 years ranged from 26% to 75.9%. Both short-term and long-term results after hepatectomy for strictly selected elderly HCC patients are almost the same as those for younger patients. However, considering physiological characteristics and the high prevalence of comorbid disease in elderly patients, it is important to assess patients more meticulously and to select them strictly if scheduled to undergo major hepatectomy.
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Mastoraki A, Tsakali A, Papanikolaou IS, Danias N, Smyrniotis V, Arkadopoulos N. Outcome following major hepatic resection in the elderly patients. Clin Res Hepatol Gastroenterol 2014; 38:462-6. [PMID: 24582424 DOI: 10.1016/j.clinre.2014.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/27/2013] [Accepted: 01/17/2014] [Indexed: 02/04/2023]
Abstract
Recent advances in operative techniques, anaesthesiologic management and intensive care have greatly reduced morbidity and mortality of major hepatectomy allowing a progressive broadening of its indications by including patients with chronic liver disorders as well as elderly subjects. It is apparent that with the aging population, more elderly patients are being referred for surgery. Selecting appropriate candidates for surgical resection is therefore crucial to maximize the benefit derived from surgery. Nevertheless, it is not clear whether advanced age itself increases surgical risk or additional age-independent variables are associated with higher operative morbidity. Regardless of the indications for surgery and the extent of planned liver resections, this population is more likely to suffer from relevant disorders. Previous studies on the safety of major liver resections in the elderly patients cite morbidity and mortality rates of approximately 30-40% and 4-5% respectively. In addition, hepatic resections for hepatocellular carcinoma or colorectal liver metastases have been reported as safe in the elderly as in the younger population. Nevertheless, a small number of investigations studied the outcome of major hepatectomy in the population over 70 years of age. The aim of our study was to evaluate overall experience with liver resections in the elderly population by comparing the early as well as the long-term outcome of the procedure in 70 years and older versus the less than 70 age group and to identify whether the age of patients alone is associated with increased rate and severity of postoperative complications.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1, Rimini Street, 12462 Chaidari, Athens, Greece.
| | - Athina Tsakali
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1, Rimini Street, 12462 Chaidari, Athens, Greece
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine, ATTIKON University Hospital, 1, Rimini Street, 12462 Chaidari, Athens, Greece
| | - Nikolaos Danias
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1, Rimini Street, 12462 Chaidari, Athens, Greece
| | - Vasilios Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1, Rimini Street, 12462 Chaidari, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1, Rimini Street, 12462 Chaidari, Athens, Greece
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Katsuta E, Tanaka S, Mogushi K, Matsumura S, Ban D, Ochiai T, Irie T, Kudo A, Nakamura N, Tanaka H, Tanabe M, Arii S. Age-related clinicopathologic and molecular features of patients receiving curative hepatectomy for hepatocellular carcinoma. Am J Surg 2014; 208:450-456. [PMID: 24972857 DOI: 10.1016/j.amjsurg.2014.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/24/2013] [Accepted: 01/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Age-related differences of clinicopathologic features, outcomes, and molecular properties of hepatocellular carcinoma remain unclarified. METHODS We classified patients who underwent hepatectomy for hepatocellular carcinoma into 3 groups by age bracket; younger group (<50 years), middle-aged group (50 to 79 years), and elderly group (≥80 years) and compared age-related features. RESULTS Hepatitis viral infection was dominant in the younger group (hepatitis B virus [HBV]; 67%) and middle-aged group (hepatitis C virus [HCV]; 56%), whereas the elderly group showed a significantly higher rate without hepatitis virus infection (absence of HBV and HCV infection, 66%; P = .0001). There was a significantly greater proportion of age-associated pre-existing comorbidity in the elderly group (89%; P = .0004). Liver cirrhosis in the elderly group (24%) was significantly lower than other groups (younger, 67%; middle-aged, 50%; P = .0058). There was no significant difference in perioperative and postoperative outcomes among these groups. Microarray analysis revealed age-related upregulation of androgen and phosphatidylinositol 3-kinase pathways in the tumor tissue and downregulation of the fibrosis-related pathways in the noncancerous liver tissue. CONCLUSIONS Based on increased correlation with the absence of HBV and HCV infection and pre-existing comorbidity, the age-related carcinogenic pathways might play a critical role in elderly hepatocarcinogenesis.
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Affiliation(s)
- Eriko Katsuta
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kaoru Mogushi
- Department of Bioinformatics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Matsumura
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Ban
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Ochiai
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takumi Irie
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kudo
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriaki Nakamura
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Bioinformatics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minoru Tanabe
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeki Arii
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Cohen MJ, Levy I, Barak O, Bloom AI, Fernández-Ruiz M, Di Maio M, Perrone F, Poon RT, Shouval D, Yau T, Shibolet O. Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: results from an international database. Liver Int 2014; 34:1109-17. [PMID: 24512125 DOI: 10.1111/liv.12486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 02/01/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) incidence among elderly patients is increasing. Trans-arterial chemo-embolization (TACE) prolongs survival in selected HCC patients. The safety and efficacy of TACE in elderly patients has not been extensively studied. The objective of this study was to assess the safety and efficacy of TACE in elderly patients (older than 75) with HCC. DESIGN Combined HCC registries (Spain, Italy, China and Israel) and cohort design analysis of patients who underwent TACE for HCC. RESULTS Five hundred and forty-eight patients diagnosed and treated between 1988 and 2010 were included in the analysis (China 197, Italy 155, Israel 102 and Spain 94,). There were 120 patients (22%) older than 75 years and 47 patients (8.6%) older than 80. Median (95% CI) survival estimates were 23 (17-28), 21 (17-26) and 19 (15-23) months (P=0.14) among patients aged younger than 65, 65-75 and older than 75 respectively. An age above 75 years at diagnosis was not associated with worse prognosis, hazard ratio of 1.05 (95% CI 0.75-1.5), controlling for disease stage, sex, diagnosis year, HBV status and stratifying per database. No differences in complication rates were found between the age groups. CONCLUSIONS TACE is safe for patients older than 75 years. Results were similar over different eras and geographical locations. Though selection bias is inherent, the results suggest overall adequate selection of patients, given the similar outcomes among the different age groups.
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Affiliation(s)
- Matan J Cohen
- Division of Internal Medicine and Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Golfieri R, Bilbao JI, Carpanese L, Cianni R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Cappelli A, Rodriguez M, Ettorre GM, Saltarelli A, Geatti O, Ahmadzadehfar H, Haug AR, Izzo F, Giampalma E, Sangro B, Pizzi G, Notarianni E, Vit A, Wilhelm K, Jakobs TF, Lastoria S. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma. J Hepatol 2013; 59:753-61. [PMID: 23707371 DOI: 10.1016/j.jhep.2013.05.025] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/19/2013] [Accepted: 05/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS The European Network on Radioembolization with Yttrium-90 resin microspheres study group (ENRY) conducted a retrospective study to evaluate the outcomes among elderly (≥ 70 years) and younger patients (<70 years) with unresectable hepatocellular carcinoma (HCC) who received radioembolization at 8 European centers. METHODS Patients with confirmed diagnosis of unresectable HCC who either progressed following resection or locoregional treatment and/or who were considered poor candidates for chemoembolization were evaluated by a multidisciplinary team for radioembolization with (90)Y-resin microspheres (SIR-Spheres; Sirtex Medical). The survival outcome and all adverse events were compared between the two age groups. RESULTS Between 2003 and 2009, 128 elderly and 197 younger patients received radioembolization. Patients in both groups had similar demographic characteristics. Many elderly and younger patients alike had multinodular, BCLC stage C disease, invading both lobes (p = 0.648). Elderly patients had a lower tumor burden, a smaller median target liver volume (p = 0.016) and appeared more likely to receive segmental treatment (p = 0.054). Radioembolization was equally well tolerated in both cohorts and common procedure-related adverse events were predominantly grade 1-2 and of short duration. No significant differences in survival between the groups were found (p = 0.942) with similar median survival in patients with early, intermediate or advanced BCLC stage disease. CONCLUSIONS Radioembolization appears to be as well-tolerated and effective for the elderly as it is for younger patients with unresectable HCC. Age alone should not be a discriminating factor for the management of HCC patients.
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Affiliation(s)
- Rita Golfieri
- Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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Nishikawa H, Kimura T, Kita R, Osaki Y. Treatment for hepatocellular carcinoma in elderly patients: a literature review. J Cancer 2013; 4:635-43. [PMID: 24155775 PMCID: PMC3805991 DOI: 10.7150/jca.7279] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/07/2013] [Indexed: 02/06/2023] Open
Abstract
An aging society means that the number of elderly patients with cancer is predicted to rise in the future. Hepatocellular carcinoma (HCC) usually develops in patients with hepatitis B virus infection, hepatitis C virus infection, or alcoholic liver disease. The risk of developing HCC is also known to be age-dependent and elderly patients sometimes present with HCC. The increased longevity of the population thus means that more elderly HCC patients are to be expected in the coming years. In general, many elderly patients are not receiving optimal therapy for malignancies, because it is often withheld from them because of perceived minimal survival advantage and the fear of potential toxicity. Comprehensive data with regard to treatment of elderly patients with HCC are currently limited. Furthermore, current guidelines for the management of HCC do not satisfy strategies according to age. Thus, there is urgent need for investigation of safety and clinical outcomes in elderly patients who receive therapy for HCC. In this review, we primarily refer to current knowledge of clinical characteristics and outcome in elderly patients with HCC who underwent different treatment approaches (i.e., surgical resection, liver transplantation, locoregional therapies, and molecular-targeting therapy).
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Affiliation(s)
- Hiroki Nishikawa
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
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