Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

355 Background: Transplant, resection, and ablation are potentially curative treatments for hepatocellular carcinoma (HCC) with limited outcome data in young-old (65-74) and older (≥75) patients. Methods: We evaluated curative treatment and relative survival (RS) outcomes in patients with HCC in 3 age groups (<65 years, 65-74 years, and ≥75 years). Patients with HCC diagnostic codes (histology 8,170-8,175, morphology C22) were identified in the SEER 18 database from 2000 to 2011. Treatments included curative (transplant, resection, radiofrequency ablation (RFA), and other ablations) and palliative therapies. Primary outcome was 5 year RS. Statistical analysis was performed using Kaplan-Meier and Chi-Square tests. Results: We identified 29,654 cases. The mean age was 62 years with almost 40% of HCC cases in patients over 65 years old. Potentially curable, localized stage rates were similar in all age groups, 46%, 48% and 46%, respectively. As a result of less resection and rare transplant use, fewer cases underwent curative treatments in the group 75 years and older in comparison to all other age groups (15% vs. 27%, p = 0.001). Five-year RS in all 3 age groups (<65 years, 65-74 years, and ≥75 years) was better after resection relative to RFA (47% vs. 35% p<0.0001, 44% vs. 37%, p=0.0093, and 43% vs. 28% p=0.0002). The highest survival was seen after liver transplant. Interestingly, among transplanted patients with HCC, 13% were 65-75 years old. Five-year RS was similar in transplanted patients 65-75 vs. those under 65 (76% vs 74% p=0.65). Conclusions: The use of curative treatments for HCC significantly decreases with age, yet there are clear survival benefits in elderly patients receiving such. Even when considering transplant, the data shows that outcome is as good in elderly patients as in younger patients. The benefit of hepatic resection appears to be superior compared to RFA in all age groups, in our analysis. [Table: see text]

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Survival of elderly patients with advanced hepatocellular carcinoma with distant metastasis in pre- and post- sorafenib era: A population based study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15643 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15643-e15643 ◽

Cited By ~ 2

Author(s):

Nibash Budhathoki ◽

Binay Kumar Shah

Keyword(s):

Hepatocellular Carcinoma ◽

Elderly Patients ◽

Distant Metastasis ◽

Survival Rates ◽

Relative Survival ◽

Population Based ◽

P Value ◽

Advanced Hepatocellular Carcinoma ◽

Significant Difference ◽

Improvement In Survival

e15643 Background: Sorafinib was approved for advanced hepatocellular carcinoma in 2007. This study was conducted to study relative survival in elderly patients with advanced hepatocellular carcinoma in presorafinib and sorafinib era. Methods: We selected elderly patients (age ≥ 65 years) with advanced hepatocellular carcinoma (distant metastasis based on SEER’s LRD staging) from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed during January 2000 to December 2013. We calculated one year and five year relative survival rates in pre- (2000-2006) and post- sorafinib (2008-2013) era by sex and ethnicity (Caucasians, African-Americans (AA) & Other) using SEER*Stat software. Results: There were total of 1533 patients in presorafinib era and 1694 patients in postsorafinib era. Of the total population, 71.30% were male and 28.70% female, 71% were Caucasian, 10% African-American and 19% were other race. Median age of patients was 73 years (65-99 years) and medial follow up period was 3 months (0-167 months) Survival rates improved significantly from pre- to post- sorafenib era (1 year RS: 10.60% ±0.80% vs 12.10±0.90%, p value = 0.001; 5 year RS: 1.10%±0.30% vs 1.8%±0.6%, p value = 0.001 ). The survival rate improved significantly for male (1 year RS: 11.60%±1.00% vs 12.30%±1.00%, p value = 0.006; 5 year RS: 1.00%±0.40% vs 1.3%± 0.6% , p value = 0.007) and Caucasian (1 year RS: 10.60%±1.00% vs 12.60%±1.10%, p value = 0.0008; 5 year RS: RS = 1.20%±0.40% vs 1.4%±0.7%, P value = 0.001) patients in post sorafenib era. There was no significant difference in the survival rates among any other cohorts examined.However in black (N = 153 vs 158 , RS = 6.80%±2.10% vs 7.80%±2.40% , p value = 0.77) or other races (N = 311 vs 311, RS = 12.20%±1.90% vs 12.80%±2.10%, p value = 0.30 ) , no significant improvement in survival was noted. Conclusions: Our study showed that relative survival rates of elderly patients with advanced hepatocellular carcinoma with distant metastasis has improved in the post-sorafenib compared to pre-sorafenib era. The improvement in survival is limited to male and Caucasian patients.

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Treatment of stage I NSCLC in elderly patients: A population-based matched-pair comparison of stereotactic radiotherapy versus surgery

Radiotherapy and Oncology ◽

10.1016/j.radonc.2011.06.029 ◽

2011 ◽

Vol 101 (2) ◽

pp. 240-244 ◽

Cited By ~ 116

Author(s):

David Palma ◽

Otto Visser ◽

Frank J. Lagerwaard ◽

Jose Belderbos ◽

Ben Slotman ◽

...

Keyword(s):

Elderly Patients ◽

Stereotactic Radiotherapy ◽

Population Based ◽

Stage I ◽

Matched Pair ◽

Pair Comparison

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A Prognostic Scoring System for Predicting Overall Survival of Patients with the TNM 8th Edition Stage I and II Hepatocellular Carcinoma After Surgery: A Population-Based Study

Cancer Management and Research ◽

10.2147/cmar.s289826 ◽

2021 ◽

Vol Volume 13 ◽

pp. 2131-2142

Author(s):

Yannan Bai ◽

Yuan'e Lian ◽

Jiayi Wu ◽

Shi Chen ◽

Jianlin Lai ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Scoring System ◽

Population Based ◽

Stage I ◽

Population Based Study ◽

8Th Edition

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Impact of Introducing Stereotactic Lung Radiotherapy for Elderly Patients With Stage I Non–Small-Cell Lung Cancer: A Population-Based Time-Trend Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2010.30.0731 ◽

2010 ◽

Vol 28 (35) ◽

pp. 5153-5159 ◽

Cited By ~ 300

Author(s):

David Palma ◽

Otto Visser ◽

Frank J. Lagerwaard ◽

Jose Belderbos ◽

Ben J. Slotman ◽

...

Keyword(s):

Lung Cancer ◽

Elderly Patients ◽

Small Cell Lung Cancer ◽

Cancer Registry ◽

Cell Lung Cancer ◽

Population Based ◽

Small Cell ◽

Stage I ◽

Small Cell Lung ◽

The Impact

Purpose Stereotactic body radiotherapy (SBRT) for stage I non–small-cell lung cancer (NSCLC) is associated with high local control rates. The impact of introducing SBRT in patients 75 years of age or older was studied using a population-based cancer registry. Methods The Amsterdam Cancer Registry was assessed in three eras: 1999 to 2001 (period A, pre-SBRT); 2002 to 2004 (period B, some availability of SBRT), and 2005 to 2007 (period C, full access to SBRT). χ2, Kaplan-Meier, and Cox regression were used to compare treatment patterns and overall survival (OS) in three treatment groups: surgery, radiotherapy (RT), or neither. Results A total of 875 elderly patients were diagnosed with stage I NSCLC in the study period. Median follow-up was 54 months. Primary treatment was surgery in 299 patients (34%), RT in 299 patients (34%), and neither in 277 patients (32%). RT use increased between periods A and C (26% v 42%, P < .01), corresponding to a decrease in untreated patients. The percentage of RT patients undergoing SBRT in periods B and C was 23% and 55%, respectively. Median survival for all patients increased from 16 months in period A to 21 months in period C (log-rank P < .01; hazard ratio [HR] = 0.65; 95% CI, 0.54 to 0.80). The improvement in OS was confined to RT patients (HR = 0.70; 95% CI, 0.49 to 0.99), whereas no significant survival improvements were seen in the other groups. Conclusion SBRT introduction was associated with a 16% absolute increase in RT use, a decline in the proportion of untreated elderly patients, and an improvement in OS.

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The Impact of Introducing Stereotactic Body Radiotherapy in Elderly Patients with Stage I NSCLC: A Population-Based Time-Trend Analysis

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.435 ◽

2010 ◽

Vol 78 (3) ◽

pp. S178-S179

Author(s):

D. Palma ◽

O. Visser ◽

F. Lagerwaard ◽

J. Belderbos ◽

B. Slotman ◽

...

Keyword(s):

Elderly Patients ◽

Trend Analysis ◽

Stereotactic Body Radiotherapy ◽

Time Trend ◽

Population Based ◽

Stage I ◽

The Impact

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Treatment and Survival of Elderly Patients with Stage I–II Pancreatic Cancer: A Report of the EURECCA Pancreas Consortium

Annals of Surgical Oncology ◽

10.1245/s10434-020-08539-x ◽

2020 ◽

Vol 27 (13) ◽

pp. 5337-5346 ◽

Cited By ~ 1

Author(s):

Jesse V. Groen ◽

◽

Tom A. Douwes ◽

Elizabeth van Eycken ◽

Lydia G. M. van der Geest ◽

...

Keyword(s):

Pancreatic Cancer ◽

Elderly Patients ◽

Primary Outcome ◽

Palliative Chemotherapy ◽

Cancer Registries ◽

Population Based ◽

Stage I ◽

Observational Cohort ◽

Neo Adjuvant Chemotherapy ◽

Non Surgical Treatment

Abstract Background Elderly patients with pancreatic cancer are underrepresented in clinical trials, resulting in a lack of evidence. Objective The aim of this study was to compare treatment and overall survival (OS) of patients aged ≥ 70 years with stage I–II pancreatic cancer in the EURECCA Pancreas Consortium. Methods This was an observational cohort study of the Belgian (BE), Dutch (NL), and Norwegian (NOR) cancer registries. The primary outcome was OS, while secondary outcomes were resection, 90-day mortality after resection, and (neo)adjuvant and palliative chemotherapy. Results In total, 3624 patients were included. Resection (BE: 50.2%; NL: 36.2%; NOR: 41.3%; p < 0.001), use of (neo)adjuvant chemotherapy (BE: 55.9%; NL: 41.9%; NOR: 13.8%; p < 0.001), palliative chemotherapy (BE: 39.5%; NL: 6.0%; NOR: 15.7%; p < 0.001), and 90-day mortality differed (BE: 11.7%; NL: 8.0%; NOR: 5.2%; p < 0.001). Furthermore, median OS in patients with (BE: 17.4; NL: 15.9; NOR: 25.4 months; p < 0.001) and without resection (BE: 7.0; NL: 3.9; NOR: 6.5 months; p < 0.001) also differed. Conclusions Differences were observed in treatment and OS in patients aged ≥ 70 years with stage I–II pancreatic cancer, between the population-based cancer registries. Future studies should focus on selection criteria for (non)surgical treatment in older patients so that clinicians can tailor treatment.

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