Background
Partial hepatectomy is an important treatment for elderly patients with hepatocellular
carcinoma. However, prediction of long-term outcomes of an individual elderly patient
after partial hepatectomy still is lacking. This study aimed to develop 2 nomograms
to pre- or postoperatively predict overall survival for these patients.
Methods
Of the 528 elderly patients (aged ≥65 years) who underwent partial hepatectomy for
hepatocellular carcinoma at the Eastern Hepatobiliary Surgery Hospital between 2008
and 2011, 425 patients served as a training cohort to develop pre- and postoperative
nomograms, and the remaining 103 patients comprised a validation cohort. The Cox proportional
hazards model was used for univariate and multivariable analyses of tumor recurrence
and overall survival. Discrimination and calibration of the models were measured using
the concordance index, calibration plots, and Kaplan-Meier curves.
Results
Based on preoperative data, the independent risk factors of overall survival were
age ≥75 years, Charlson score, α-fetoprotein ≥20 μg/L, hepatitis B virus-deoxyribonucleic
acid ≥104 IU/mL, and tumor diameter. Based on postoperative data, nonanatomic hepatectomy,
absence of tumor encapsulation, and presence of microvascular invasion were additional
independent risk factors. These independent predictors were incorporated into the
pre- and postoperative nomograms, respectively. The concordance indexes of the 2 nomograms
for overall survival prediction were 0.70 (95% confidence interval, 0.67–0.74) and
0.72 (0.69–0.78), respectively. Both nomograms accurately predicted 1-, 3-, and 5-year
overall survival probability, and their predictive performances were optimally validated.
Conclusion
The proposed 2 nomograms showed good individualized predictive performance in elderly
patients with hepatocellular carcinoma before and after partial hepatectomy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.Int J Cancer. 2010; 127: 2893-2917
- The changing pattern of epidemiology in hepatocellular carcinoma.Dig Liver Dis. 2010; 42: S206-S214
- The impact of anti-HBV treatment on the occurrence and recurrence of hepatocellular carcinoma: focus on Asian studies.Discovery Med. 2015; 19: 89-99
- Antiviral therapy for chronic hepatitis B virus infection and development of hepatocellular carcinoma in a US population.Clin Gastro Hepatol. 2014; 12: 885-893
- Future of cancer incidence in the United States: burdens upon an aging, changing nation.J Clin Oncol. 2009; 27: 2758-2765
- Anatomical versus non-anatomical resection for hepatocellular carcinoma.Br J Surg. 2015; 102: 776-784
- Long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma undergoing hepatectomy.J Gastrointest Surg. 2009; 13: 1627-1635
- Surgical resection for hepatocellular carcinoma: clinical outcomes and safety in elderly patients.Eur J Gastroenterol Hepatol. 2013; 25: 912-919
- Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies.Liver Int. 2009; 29: 502-510
- Do young hepatocellular carcinoma patients with relatively good liver function have poorer outcomes than elderly patients?.J Gastroenterol Hepatol. 2007; 22: 1226-1231
- Predictors of survival after resection of early hepatocellular carcinoma.Ann Surg. 2009; 249: 799-805
- Changing paradigm in the management of hepatocellular carcinoma improves the survival benefit of early detection by screening.Ann Surg. 2008; 247: 666-673
- 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. 2014; 209: 733-741
- EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.Eur J Cancer. 2012; 48: 599-641
- Management of hepatocellular carcinoma in Japan: consensus-based clinical practice guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version.Dig Dis. 2011; 29: 339-364
- The Singapore Liver Cancer Recurrence (SLICER) Score for relapse prediction in patients with surgically resected hepatocellular carcinoma.PLoS One. 2015; 10: e0118658
- Prognostic nomograms for prediction of recurrence and survival after curative liver resection for hepatocellular carcinoma.Ann Surg. 2015; 261: 939-946
- A novel prognostic nomogram accurately predicts hepatocellular carcinoma recurrence after liver transplantation: analysis of 865 consecutive liver transplant recipients.J Am Coll Surg. 2015; 220: 416-427
- How to build and interpret a nomogram for cancer prognosis.J Clin Oncol. 2008; 26: 1364-1370
- Nomogram prediction of metachronous colorectal neoplasms in patients with colorectal cancer.Ann Surg. 2015; 261: 926-932
- Performance status assessment in cancer patients. An inter-observer variability study.Br J Cancer. 1993; 67: 773-775
- Overexpression of aspartyl-(asparaginyl)-beta-hydroxylase in hepatocellular carcinoma is associated with worse surgical outcome.Hepatol. 2010; 52: 164-173
- Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child-Pugh grade A cirrhosis.Br J Surg. 2012; 99: 1701-1710
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chron Dis. 1987; 40: 373-383
- ASA physical status classifications: a study of consistency of ratings.Anesthesiol. 1978; 49: 239-243
- Partial hepatectomy vs transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria: a RCT.J Hepatol. 2014; 61: 82-88
- Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma.Surgery. 2014; 155: 512-521
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies.Cancer. 1954; 7: 462-503
- Hepatectomy for hepatocellular carcinoma in elderly patients aged 75 years or more.J Gastrointest Surg. 2009; 13: 695-701
- High hepatitis B viral load predicts recurrence of small hepatocellular carcinoma after curative resection.J Gastrointest Surg. 2010; 14: 1111-1120
- Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy.J Clin Oncol. 2013; 31: 1188-1195
- Outcome of repeat hepatectomy in patients with hepatocellular carcinoma aged 75 years and older.Surgery. 2010; 147: 696-703
- Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century.Surgery Today. 2015; 45: 851-857
- Hepatic resection for hepatocellular carcinoma in the elderly.J Am Coll Surg. 2001; 192: 38-46
- Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery?.J Surg Oncol. 2011; 104: 284-291
Article info
Publication history
Published online: October 21, 2017
Accepted:
July 28,
2017
Footnotes
Supported by the State Key Project on Infectious Diseases of China (2012ZX10002-016 to F.S.) and the Creative Research Groups of National Natural Science Foundation of China (30921006 to F.S.).
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
