高龄肝细胞癌病人的临床特点和肝切除的治疗效果

目的探求年龄超过75岁的肝细胞癌能否通过肝切除术获益。方法 2007年1月至2011年1月间796例肝细胞癌进行了根治性肝切除术。68例年龄超过75岁的病人定为高龄病人组,从剩余的728例病人中随机选择500例(年龄小于75岁)作为对照组,两组的临床病理资料和肝切除术后的结果进行了比较。结果同对照组相比较,高龄病人具有较高的丙型肝炎病毒(hepatitis C virus,HCV)感染发生率(P0.001),较多的术前基础病,如:高血压(P0.001)和冠心病(P0.001),较少的术中出血(P0.001)和较高的术后肺部感染发生率(P0.001),两组其他术后并发症发生率和手术期病死率差异无统计学意义。高龄病人的总体生存率显著低于对照组(P=0.022);但无病生存率两组相比差异无统计学意义(P=0.095)。多因素分析表明,较高的术前甲胎蛋白(AFP)水平和较大的肿瘤直径是影响高龄病人总体生存期和无瘤生存期的独立危险因素。结论尽管总体生存率高龄组较对照组差,但术后无瘤生存率两组比较差异无统计学意义。对于年龄大于75岁的肝细胞癌病人来说,年龄本身不是肝切除术的禁忌证。经过选择的高龄病人可以通过肝切除术获得一定的治疗效果。

Clinical characteristics and surgical outcomes of elderly patients with hepatocellular carcinoma undergoing hepatotectomy

Objective To investigate the clinical characteristics and outcomes of elderly patients (over 75 years old) with hepatocellular carcinoma (HCC) undergoing curative hepatectomy.Methods Between January 2007 and January 2011,68 elderly patients who were defined as those older than 75 years underwent curative hepatectomy for HCC.Clinicopathological data and outcomes after hepatectomy of 68 elderly patients and 500 younger patients who were randomly collected were analyzed.Results The elderly group had higher hepatitis C virus infection rate (P＜0.001),higher concomitant diseases,such as hypertension (P＜0.001),coronary heart disease (P＜0.001),less in-operative blood loss (P＜0.001),and higher pulmonary infection (P＜0.001) than the control group.There were no significant differences in other postoperative complication rate and mortality between the two groups.The overall survival rate was lower in the elderly group than in the control group (P =0.022),but the disease-free survival rate was similar between the two groups (P =0.095).Multivariate analysis showed that elevated preoperative AFP levels and larger tumor diameters were independent risk factors for overall and disease-free survival.Conclusions Although the overall survival was worse in elderly patients than in younger patients,the disease-free survival was similar.Older than 75 years alone is not a contraindication to hepatectomy.Selected elderly patients with HCC might benefit from hepatectomy.