Survival Analysis of Hepatocellular Carcinoma: A Comparison Between Young Patients and Aged Patients

Abstract

Background: To compare the clinicopathological features and prognosis between younger and aged patients with hepatocellular carcinoma (HCC).

Methods: We analyzed the outcome of 451 HCC patients underwent liver resection, transcatheter arterial chemoembolization and radiofrequency ablation, respectively. Then risk factors for aged and younger patients' survival were evaluated by multivariate analysis, respectively.

Results: The patients who were older than 55 years old were defined as the older group. The overall survival for aged patients was significantly worse than those younger patients. The younger patients had similar liver functional reserve but more aggressive tumor factors than aged patients. Cox regression analysis showed that the elevated levels of aspartate aminotransferase (AST) (Wald χ2 = 3.963, P = 0.047, hazard ratio [HR] =1.453, 95% confidence interval [CI]: 1.006-2.098), lower albumin (Wald χ2 = 12.213, P < 0.001, HR = 1.982, 95% CI: 1.351-2.910), tumor size (Wald χ2 = 8.179, P = 0.004, HR = 1.841, 95% CI: 1.212-2.797), and higher alpha-fetoprotein level (Wald χ2 = 4.044, P = 0.044, HR = 1.465, 95% CI: 1.010-2.126) were independent prognostic factors for aged patients, while only elevated levels of AST (Wald χ2 = 14.491, P < 0.001, HR = 2.285, 95% CI: 1.493-3.496) and tumor size (Wald χ2 = 21.662, P < 0.001, HR = 2.928, 95% CI: 1.863-4.604) were independent prognostic factors for younger patients.

Conclusions: Age is a risk factor to determine the prognosis of patients with HCC. Aged patients who have good liver functional reserve are still encouraged to receive curative therapy.

Figure 1

Kaplan–Meier curves of overall survival (a) and disease-free survival (b) for the whole 451 hepatocellular carcinoma patients enrolled in this study, who underwent liver resection, transcatheter arterial chemoembolization, or ablation.

Figure 2

Impact of age on the overall survival and disease-free survival of hepatocellular carcinoma patients following surgical resection (a and d), ablation (b and e) and transcatheter arterial chemoembolization (c and f), respectively, as classified by the cut-off value of age.

Figure 3

Relationship between age, liver function, and tumor characteristics. Correlation analysis was made between age and different factors, such as albumin (a), total bilirubin (b), and alpha-fetoprotein (c).