内容紹介
Summary
Although the first-line treatment for hepatocellular carcinoma(HCC)is hepatectomy, extreme elderly(80 years or older)patients often tend to have a variety of underlying diseases and decreased cardiopulmonary function, which means that surgery involves a high risk. In this case, we examined the safety and efficacy of hepatectomy performed in an extreme elderly patient with HCC. Of the patients with HCC that underwent initial hepatectomy at Kobe University Hospital(n=348)between 2009 and 2015, 23 patients aged 80 years or older at the time of surgery(Group 1, n=23)and those younger than 80 years at the time(Group 2, n=325)were compared, based on parameters related to safety and prognosis. We did not identify differences between the 2 groups with respect to blood loss and operating time. Intraoperative blood transfusion was more common in Group 1. There was no significant difference between the 2 groups with respect to complications of Grade Ⅲ or higher. The median survival of Group 2 patients following hepatectomy(42 months)was better than that of Group 1 patients(34 months), but there was no significant difference between the 2 groups(p=0.429). Furthermore, when the same parameters were compared after adjusting for and matching propensity scores, there were no significant differences in complications, hospitalization periods, and prognosis between the 2 groups. Through proper assessment of oncologic factors and patient risk factors, hepatectomy can be performed safely and effectively even for extreme elderly patients with HCC. If there is no other disease regulating the prognosis, we can expect to achieve similar prognosis in non-extreme elderly patients. Hence, treatments should not be limited solely based on a patient being extremely elderly; rather, proactive treatments should be considered.
要旨
肝細胞癌(HCC)治療の第一選択は肝切除術であるが,超高齢者(80歳以上)は多彩な基礎疾患や心肺機能の低下があることが多く,手術のリスクが高い。今回,超高齢者HCC患者に対して肝切除術を施行した症例を対象として検討し,その安全性と有効性を検討した。当院で2009～2015年までに初回肝切除術を施行したHCC症例348例のうち,手術施行時に80歳以上の23例(Group 1)と80歳未満の325例(Group 2)の安全性と予後についての項目を比較検討した。出血,手術時間は両群間に差を認めなかった。術中輸血はGroup 1 56.5%,Group 2 29.2%(p=0.0060)と高齢者に多い傾向にあった。Clavien-Dindo分類Grade Ⅲ以上の合併症は両群に有意差は認めなかった。Group 1の肝切除後の生存期間中央値45か月,5年生存率は30.7%で,Group 2の生存期間中央値52か月,5年生存率47.2%とGroup 2に良好な傾向は認めたが,有意差は認めなかった。さらにpropensity score(PS)による調整,マッチングを行った後に同様の項目を比較したところ,両群の合併症,入院期間,予後に有意差は認めなかった。適切な腫瘍学的因子,患者のリスクファクター評価により,超高齢者HCCに対する肝切除術も安全かつ有効に施行可能であった。他に予後を規定する他疾患がなければ非超高齢者と同等な予後が期待できると考えられる。超高齢者というだけで治療法を制限せず,積極的な治療も考慮するべきだと考えられる。
目次
Although the first-line treatment for hepatocellular carcinoma(HCC)is hepatectomy, extreme elderly(80 years or older)patients often tend to have a variety of underlying diseases and decreased cardiopulmonary function, which means that surgery involves a high risk. In this case, we examined the safety and efficacy of hepatectomy performed in an extreme elderly patient with HCC. Of the patients with HCC that underwent initial hepatectomy at Kobe University Hospital(n=348)between 2009 and 2015, 23 patients aged 80 years or older at the time of surgery(Group 1, n=23)and those younger than 80 years at the time(Group 2, n=325)were compared, based on parameters related to safety and prognosis. We did not identify differences between the 2 groups with respect to blood loss and operating time. Intraoperative blood transfusion was more common in Group 1. There was no significant difference between the 2 groups with respect to complications of Grade Ⅲ or higher. The median survival of Group 2 patients following hepatectomy(42 months)was better than that of Group 1 patients(34 months), but there was no significant difference between the 2 groups(p=0.429). Furthermore, when the same parameters were compared after adjusting for and matching propensity scores, there were no significant differences in complications, hospitalization periods, and prognosis between the 2 groups. Through proper assessment of oncologic factors and patient risk factors, hepatectomy can be performed safely and effectively even for extreme elderly patients with HCC. If there is no other disease regulating the prognosis, we can expect to achieve similar prognosis in non-extreme elderly patients. Hence, treatments should not be limited solely based on a patient being extremely elderly; rather, proactive treatments should be considered.
要旨
肝細胞癌(HCC)治療の第一選択は肝切除術であるが,超高齢者(80歳以上)は多彩な基礎疾患や心肺機能の低下があることが多く,手術のリスクが高い。今回,超高齢者HCC患者に対して肝切除術を施行した症例を対象として検討し,その安全性と有効性を検討した。当院で2009～2015年までに初回肝切除術を施行したHCC症例348例のうち,手術施行時に80歳以上の23例(Group 1)と80歳未満の325例(Group 2)の安全性と予後についての項目を比較検討した。出血,手術時間は両群間に差を認めなかった。術中輸血はGroup 1 56.5%,Group 2 29.2%(p=0.0060)と高齢者に多い傾向にあった。Clavien-Dindo分類Grade Ⅲ以上の合併症は両群に有意差は認めなかった。Group 1の肝切除後の生存期間中央値45か月,5年生存率は30.7%で,Group 2の生存期間中央値52か月,5年生存率47.2%とGroup 2に良好な傾向は認めたが,有意差は認めなかった。さらにpropensity score(PS)による調整,マッチングを行った後に同様の項目を比較したところ,両群の合併症,入院期間,予後に有意差は認めなかった。適切な腫瘍学的因子,患者のリスクファクター評価により,超高齢者HCCに対する肝切除術も安全かつ有効に施行可能であった。他に予後を規定する他疾患がなければ非超高齢者と同等な予後が期待できると考えられる。超高齢者というだけで治療法を制限せず,積極的な治療も考慮するべきだと考えられる。