The prognosis of elderly patients with hepatocellular carcinoma after curative hepatectomy a multicenter competing risk analysis

Background: Non-cancer-specific death (NCSD) is an important factor that needs to be consid-ered in patients with malignancy, as it can affect their long-term prognosis. In particular, the effect of age on patients with hepatocellular carcinoma (HCC) after hepatectomy requires clar-ification. This study aims to examine the impact of age on patients with HCC after hepatectomy and to identify independent risk factors of survival. Methods: Patients with HCC that fell within the Milan Criteria and had undergone curative hepatec-tomy were included in this study. The patients were divided into two groups: young patients (age <70) and elderly patients (age >70). Perioperative complications, cancer-specific death (CSD), recurrence, and NCSD were all recorded and analyzed. Multivariate analyses were performed to identify independent risk factors of survival using Fine and Gray's competing-risk regression model. Results: Among 1,354 analytic patients, 1,068 (78.7%) were stratified into the young group and 286 (21.3%) into the elderly group. The elderly group had a higher 5-year cumulative incidence of NCSD (12.6% vs. 3.7% for the young group, P < 0.001), but lower 5-year cumulative incidences of recurrence (20.3% vs. 21.1% for the young group, P = 0.041) and CSD (14.3% vs. 15.5% for the young group, P = 0.066). Multivariate competing-risk regression analyses revealed that age was independently associated with NCSD (subdistribution hazard ratio (SHR) 3.003, 95%CI: 2.082-4.330, P < 0.001), but not with recurrence (SHR 0.837, 95%CI: 0.659-1.060, P = 0.120) or CSD (SHR 0.736, 95%CI: 0.537-1.020, P = 0.158). Conclusion: For patients with early-stage HCC after hepatectomy, older age was independently associated with NCSD, but not recurrence and CSD. (c) 2023 Elsevier Masson SAS. All rights reserved.

Automated summary

This study aims to examine the impact of age on the survival of patients with hepatocellular carcinoma (HCC) after hepatectomy and to identify independent risk factors. The results indicate that age is associated with non-cancer-specific death (NCSD), but not with recurrence and cancer-specific death (CSD).