title: Surgical resection for hepatocellular carcinoma: clinical outcomes and safety in elderly patients.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical outcomes and safety of surgical resection for hepatocellular carcinoma between patients older than 75 years of age (elderly group) and those younger than 75 years (control group).
  
  
  METHODS
  A total of 92 patients were included in the elderly group and 206 patients were included in the control group. Clinical outcomes including overall survival, recurrence-free survival, and safety were compared between these two groups after initial surgery.
  
  
  RESULTS
  The mean (±SD) observation periods were 2.5 ± 1.8 years in the elderly group and 3.1 ± 2.2 years in the control group. The 1, 3, and 5-year overall survival rates after surgery were 90.0, 73.3, and 43.0%, respectively, in the elderly group and 91.0, 77.5, and 64.4%, respectively, in the control group (P=0.188). The corresponding recurrence-free survival rates were 66.3, 38.8, and 26.2%, respectively, in the elderly group and 66.3, 38.8, and 22.2%, respectively, in the control group (P=0.634). Multivariate analysis identified a total bilirubin level greater than 1.0 mg/dl (P=0.003), a serum albumin level greater than 4.0 g/dl (P=0.005), an α-fetoprotein level greater than 100 ng/ml (P<0.001), and microvascular invasion (P<0.001) as significant factors linked to overall survival, and tumor number (P=0.014) and microvascular invasion (P=0.008) were significant factors associated with recurrence-free survival. There was no significant difference between the two groups in terms of surgery-related serious adverse events (P>0.999).
  
  
  CONCLUSIONS
  Surgical resection appears to be a safe and feasible procedure for the treatment of hepatocellular carcinoma in elderly patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan. h-nishikawa@osaka-med.jrc.or.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Arimoto
authors.forename: Tomoko
authors.initials: T
authors.lastname: Wakasa
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kita
authors.forename: Toru
authors.initials: T
authors.lastname: Kimura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osaki
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; C422455:ALB protein, human; D012709:Serum Albumin; D000509:alpha-Fetoproteins; D001663:Bilirubin; D000075462:Serum Albumin, Human