Supplementary Material for: Characteristics and Outcomes of Elderly Hepatocellular Carcinoma Patients following Surgical Resection: Systematic Review and Meta-analysis

Background & Aims: Due to ageing of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence free survival (RFS) and complication rates in elderly HCC patients undergoing resection. Methods: We searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020 for studies reporting outcomes in elderly (age ≥ 65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model. Results: We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI 72.89-76.02), 75.54% were male (95% CI 72.53-78.32) and 66.73% had cirrhosis (95% CI 43.93-83.96). The mean tumor size was 5.50 cm (95% CI 4.71-6.29) and 16.01% had multiple tumors (95% CI 10.74-23.19). The 1-year (86.02% versus 86.66%, p=0.84) and 5-year OS (51.60% versus 53.78%) between non-elderly versus elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% versus 73.26%, p=0.11) and 5-year RFS (31.57% versus 30.25%, p=0.67) in non-elderly versus elderly patients. There was a higher rate of minor complications (21.95% versus 13.71%, p=0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p=0.43) Conclusion: This data shows that overall survival, recurrence and major complications after liver resection for HCC are comparable between elderly and non-elderly patients, and may inform clinical management of HCC in this population.

研究背景与目的：随着全球人口老龄化，老年患者肝细胞癌（hepatocellular carcinoma, HCC）的发病率日益升高，但此类患者接受根治性肝切除术后的预后尚不明确。本研究采用荟萃分析方法，旨在评估接受手术切除的老年HCC患者的总生存期（overall survival, OS）、无复发生存期（recurrence free survival, RFS）以及并发症发生率。方法：本研究检索了PubMed、Embase及Cochrane数据库自建库至2020年11月10日的相关文献，筛选报道了接受根治性手术切除的老年（年龄≥65岁）HCC患者预后的研究。采用随机效应模型生成合并效应量。结果：本研究共筛选出8598篇文献，最终纳入42项研究，涉及7778例老年患者。纳入研究的患者平均年龄为74.45岁（95%置信区间（confidence interval, CI）：72.89~76.02），其中男性占比75.54%（95%置信区间：72.53~78.32），合并肝硬化者占比66.73%（95%置信区间：43.93~83.96）。患者的平均肿瘤直径为5.50cm（95%置信区间：4.71~6.29），存在多灶性肿瘤者占比16.01%（95%置信区间：10.74~23.19）。非老年患者与老年患者的1年总生存率（86.02% vs 86.66%，p=0.84）及5年总生存率（51.60% vs 53.78%）均无显著差异。同理，两组患者的1年无复发生存率（67.32% vs 73.26%，p=0.11）及5年无复发生存率（31.57% vs 30.25%，p=0.67）亦无统计学差异。与非老年患者相比，老年患者的轻度并发症发生率更高（21.95% vs 13.71%，p=0.03），但重度并发症发生率无显著差异（p=0.43）。结论：本研究数据表明，肝细胞癌患者接受肝切除术后的总生存期、肿瘤复发情况及重度并发症发生率在老年与非老年群体中无显著差异，该结果可为该人群的肝细胞癌临床诊疗提供参考依据。