Predictive Value of the Age-Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular C
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ORIGINAL SCIENTIFIC REPORT
Predictive Value of the Age-Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma Hiroji Shinkawa1 • Shogo Tanaka1 • Shigekazu Takemura1 • Ryosuke Amano1 Kenjiro Kimura1 • Takayoshi Nishioka1 • Toru Miyazaki1 • Shoji Kubo1
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Accepted: 1 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background This study aimed to evaluate the impact of the age-adjusted Charlson comorbidity index (ACCI) on outcomes after hepatic resection for hepatocellular carcinoma (HCC). Methods We assessed 763 patients who underwent hepatic resection for HCC. The ACCI scores were categorized as follows: ACCI B 5, ACCI = 6, and ACCI C 7. Results A multivariate analysis showed that the odds ratios for postoperative complications in ACCI = 6 and ACCI C 7 groups, with reference to ACCI B 5 group, were 0.71 (p = 0.41) and 4.15 (p \ 0.001), respectively. The hazard ratios for overall survival of ACCI = 6 and ACCI C 7 groups, with reference to ACCI B 5 group, were 1.52 (p = 0.023) and 2.45 (p \ 0.001), respectively. The distribution of deaths due to HCC-related, liver-related, and other causes was 68.2%, 11.8%, and 20% in ACCI B 5 group, 47.2%, 13.9%, and 38.9% in ACCI = 6 group, and 27.3%, 9.1%, and 63.6% in ACCI C 7 group (p = 0.053; ACCI B 5 vs. = 6, p = 0.19; ACCI = 6 vs. C 7, p \ 0.001; ACCI B 5 vs. C 7). In terms of the treatment for HCC recurrence in ACCI B 5, ACCI = 6, and ACCI C 7 groups, adaptation rate of surgical resection was 20.1%, 7.3%, and 11.1% and the rate of palliative therapy was 4.3%, 12.2%, and 22.2%, respectively. Conclusions The ACCI predicted the short-term and long-term outcomes after hepatic resection of HCC. These findings will help physicians establish a treatment strategy for HCC patients with comorbidities.
Introduction Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer and third leading cause of cancer-related death in the world [1, 2]. Hepatic resection is commonly accepted as the first-line curative treatment for HCC in patients with Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05686-w) contains supplementary material, which is available to authorized users. & Hiroji Shinkawa [email protected] 1
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
preserved liver function [3]; however, it is frequently associated with morbidities related to blood loss and loss of functional liver tissue. Along with the improvement in imaging technology, operative instrumentation, and perioperative management, perioperative mortality rate has decreased to 2–4% from 10% in the 1980s [4, 5]. However, the mortality rate was reportedly increased in patients with a higher burden of preoperative comorbidity and poor preoperative condition [5, 6]. Recently, the number of elderly patients with HCC has increased in many countries, and elderly patients frequently hav
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