World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 14, Number 2, April 2023, pages 125-134

Overall Survival Rates Become Similar Between Percutaneous Ablation and Hepatic Resection With Increasing Age Among Elderly Patients With Early Hepatocellular Carcinoma

Figure 1. Overall survival analyses of patients stratified by age after IPTW. IPTW: inverse probability of treatment weighting.

Figure 2. Subgroup overall survival analyses of patients with a single tumor stratified by tumor size among different age groups after IPTW. IPTW: inverse probability of treatment weighting.

**Table 1.** Baseline Information of Patients Stratified by Age
	Age 65 - 69	Age 70 - 74	Age ≥ 75	P
AFP: α-fetoprotein; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; HBV: hepatitis B virus; HCC: hepatocellular carcinoma; PLT: platelet; PT: prothrombin time; INR: international normalized ratio; SCr: serum creatinine; TBIL: total bilirubin.
Treatment				< 0.001
Resection	362 (55.4%)	132 (44.0%)	67 (34.9%)
Ablation	291 (44.6%)	168 (56.0%)	125 (65.1%)
Age	66.50 ± 1.42	71.85 ± 1.45	78.61 ± 3.52	< 0.001
Sex				0.19
Male	535 (81.9%)	231 (77.0%)	152 (79.2%)
Female	118 (18.1%)	69 (23.0%)	40 (20.8%)
Background disease of the liver				0.001
HBV infection	435 (66.6%)	181 (60.3%)	101 (52.6%)
Other	218 (33.4%)	119 (39.7%)	91 (47.4%)
Comorbid illness
Hypertension	180 (27.6%)	111 (37.0%)	88 (45.8%)	< 0.001
Diabetes	108 (16.5%)	51 (17.0%)	42 (21.9%)	0.22
Heart disease	46 (7.0%)	32 (10.7%)	29 (15.1%)	0.002
Tumor size	28.39 ± 11.15	29.02 ± 10.91	29.48 ± 10.99	0.43
Tumor count				0.09
1	573 (87.7%)	256 (85.3%)	154 (80.2%)
2	61 (9.3%)	33 (11.0%)	26 (13.5%)
3	19 (2.9%)	11 (3.7%)	12 (6.2%)
AFP				0.23
< 10	300 (45.9%)	121 (40.3%)	92 (47.9%)
10 - 100	150 (23.0%)	62 (20.7%)	46 (24.0%)
100 - 1,000	114 (17.5%)	65 (21.7%)	31 (16.1%)
> 1,000	89 (13.6%)	52 (17.3%)	23 (12.0%)
ALT	42.07 ± 63.37	35.16 ± 28.34	32.76 ± 25.85	0.03
AST	42.27 ± 52.45	39.46 ± 28.16	36.97 ± 27.23	0.29
ALB	41.66 ± 15.45	40.51 ± 4.77	40.51 ± 4.03	0.28
TBIL	16.69 ± 18.91	15.70 ± 8.65	15.05 ± 6.85	0.35
PLT	146.00 ± 65.90	147.59 ± 68.92	148.23 ± 63.27	0.89
PT	12.70 ± 1.76	12.87 ± 1.69	12.89 ± 1.82	0.23
INR	1.07 ± 0.12	1.08 ± 0.12	1.06 ± 0.10	0.35
SCr	77.56 ± 26.87	80.13 ± 54.37	80.36 ± 23.22	0.46
Child-Pugh class				0.36
A	620 (94.9%)	286 (95.3%)	187 (97.4%)
B	33 (5.1%)	14 (4.7%)	5 (2.6%)
C	0 (0%)	0 (0%)	0 (0%)
Liver cirrhosis				0.17
Yes	269 (41.2%)	142 (47.3%)	78 (40.6%)
No	384 (58.8%)	158 (52.7%)	114 (59.4%)
Causes of death
HCC-related death	111 (90.2%)	58 (76.3%)	35 (76.1%)	0.035
Liver-related death	10 (8.1%)	13 (17.1%)	8 (17.4%)
Other causes	2 (1.6%)	5 (6.6%)	3 (6.5%)

Table 1. Baseline Information of Patients Stratified by Age

Age 65 - 69

Age 70 - 74

Age ≥ 75

AFP: α-fetoprotein; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; HBV: hepatitis B virus; HCC: hepatocellular carcinoma; PLT: platelet; PT: prothrombin time; INR: international normalized ratio; SCr: serum creatinine; TBIL: total bilirubin.

Treatment

< 0.001

Resection

362 (55.4%)

132 (44.0%)

67 (34.9%)

Ablation

291 (44.6%)

168 (56.0%)

125 (65.1%)

Age

66.50 ± 1.42

71.85 ± 1.45

78.61 ± 3.52

< 0.001

Sex

0.19

Male

535 (81.9%)

231 (77.0%)

152 (79.2%)

Female

118 (18.1%)

69 (23.0%)

40 (20.8%)

Background disease of the liver

0.001

HBV infection

435 (66.6%)

181 (60.3%)

101 (52.6%)

Other

218 (33.4%)

119 (39.7%)

91 (47.4%)

Comorbid illness

Hypertension

180 (27.6%)

111 (37.0%)

88 (45.8%)

< 0.001

Diabetes

108 (16.5%)

51 (17.0%)

42 (21.9%)

0.22

Heart disease

46 (7.0%)

32 (10.7%)

29 (15.1%)

0.002

Tumor size

28.39 ± 11.15

29.02 ± 10.91

29.48 ± 10.99

0.43

Tumor count

0.09

573 (87.7%)

256 (85.3%)

154 (80.2%)

61 (9.3%)

33 (11.0%)

26 (13.5%)

19 (2.9%)

11 (3.7%)

12 (6.2%)

AFP

0.23

< 10

300 (45.9%)

121 (40.3%)

92 (47.9%)

10 - 100

150 (23.0%)

62 (20.7%)

46 (24.0%)

100 - 1,000

114 (17.5%)

65 (21.7%)

31 (16.1%)

> 1,000

89 (13.6%)

52 (17.3%)

23 (12.0%)

ALT

42.07 ± 63.37

35.16 ± 28.34

32.76 ± 25.85

0.03

AST

42.27 ± 52.45

39.46 ± 28.16

36.97 ± 27.23

0.29

ALB

41.66 ± 15.45

40.51 ± 4.77

40.51 ± 4.03

0.28

TBIL

16.69 ± 18.91

15.70 ± 8.65

15.05 ± 6.85

0.35

PLT

146.00 ± 65.90

147.59 ± 68.92

148.23 ± 63.27

0.89

12.70 ± 1.76

12.87 ± 1.69

12.89 ± 1.82

0.23

INR

1.07 ± 0.12

1.08 ± 0.12

1.06 ± 0.10

0.35

SCr

77.56 ± 26.87

80.13 ± 54.37

80.36 ± 23.22

0.46

Child-Pugh class

0.36

620 (94.9%)

286 (95.3%)

187 (97.4%)

33 (5.1%)

14 (4.7%)

5 (2.6%)

0 (0%)

Liver cirrhosis

0.17

Yes

269 (41.2%)

142 (47.3%)

78 (40.6%)

384 (58.8%)

158 (52.7%)

114 (59.4%)

Causes of death

HCC-related death

111 (90.2%)

58 (76.3%)

35 (76.1%)

0.035

Liver-related death

10 (8.1%)

13 (17.1%)

8 (17.4%)

Other causes

2 (1.6%)

5 (6.6%)

3 (6.5%)

**Table 2.** Baseline Information of Patients Stratified by Age and Treatment Type After IPTW
	65 - 69 years of age after IPTW	70 - 74 years of age after IPTW	≥ 75 years of age after IPTW
^aThe sample size was adjusted because of IPTW. IPTW: inverse probability of treatment weighting; AFP: α-fetoprotein; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; HBV: hepatitis B virus; PLT: platelet; PT: prothrombin time; INR: international normalized ratio; SCr: serum creatinine; TBIL: total bilirubin.
Age	66.5 ± 1.5	66.5 ± 1.4	0.96	71.8 ± 1.4	71.8 ± 1.4	1.00	77.9 ± 2.8	78.6 ± 3.6	0.07
Sex			0.79			0.40			0.35
Male	496 (82.3%)	548 (81.7%)		199 (76.8%)	252 (79.7%)		131 (84.5%)	150 (80.6%)
Female	107 (17.7%)	123 (18.3%)		60 (23.2%)	64 (20.3%)		24 (15.5%)	36 (19.4%)
Background disease of the liver			0.86			0.27			0.13
HBV infection	380 (63.0%)	436 (64.9%)		136 (52.7%)	181 (57.3%)		73 (47.1%)	103 (55.4%)
Other	223 (37.0%)	236 (35.1%)		122 (47.3%)	135 (42.7%)		82 (52.9%)	83 (44.6%)
Comorbid illness
Hypertension	156 (25.9%)	178 (26.5%)	0.79	81 (31.4%)	132 (41.6%)	0.11	73 (47.1%)	81 (43.8%)	0.54
Diabetes	96 (15.9%)	108 (16.1%)	0.93	53 (20.5%)	61 (19.2%)	0.71	32 (20.6%)	38 (20.5%)	0.98
Heart disease	44 (7.3%)	49 (7.3%)	1.00	26 (10.0%)	46 (14.6%)	0.10	23 (14.8%)	25 (13.5%)	0.73
Tumor size	29.0 ± 11.5	28.4 ± 11.0	0.35	28.8 ± 11.5	29.1 ± 10.3	0.80	30.2 ± 11.5	28.3 ± 10.2	0.11
Tumor count			0.10			0.49			0.03
1	544 (90.2%)	584 (87.0%)		221 (85.3%)	259 (82.0%)		137 (88.4%)	149 (80.1%)
2	51 (8.5%)	68 (10.2%)		31 (12.0%)	44 (13.9%)		16 (10.3%)	25 (13.4%)
3	8 (1.3%)	19 (2.8%)		7 (2.7%)	13 (4.1%)		2 (1.3%)	12 (6.5%)
AFP			0.44			0.26			0.46
< 10	288 (47.7%)	302 (45.0%)		136 (52.7%)	146 (46.1%)		86 (55.5%)	89 (48.1%)
10 - 100	131 (21.7%)	160 (23.8%)		46 (17.8%)	54 (17.0%)		34 (21.9%)	42 (22.7%)
100 - 1,000	110 (18.2%)	137 (20.4%)		52 (20.2%)	75 (23.7%)		18 (11.6%)	31 (16.8%)
> 1,000	75 (12.4%)	72 (10.7%)		24 (9.3%)	42 (13.2%)		17 (11.0%)	23 (12.4%)
ALT	43.1 ± 66.6	43.2 ± 50.5	0.98	33.7 ± 24.1	31.6 ± 26.7	0.32	30.7 ± 20.6	32.9 ± 25.6	0.39
AST	42.6 ± 53.5	42.1 ± 40.4	0.87	37.8 ± 23.6	36.7 ± 28.2	0.63	32.9 ± 16.9	37.7 ± 28.5	0.07
ALB	42.0 ± 15.9	41.3 ± 4.5	0.27	41.0 ± 4.4	40.7 ± 4.8	0.46	41.4 ± 3.5	40.3 ± 4.1	0.01
TBIL	15.9 ± 15.1	15.8 ± 15.2	0.88	15.2 ± 6.6	15.3 ± 8.8	0.89	13.7 ± 5.5	14.9 ± 6.7	0.07
PLT	151.5 ± 64.9	145.4 ± 63.3	0.09	159.0 ± 58.3	158.7 ± 81.5	0.98	152.2 ± 61.4	142.7 ± 58.4	0.14
PT	12.4 ± 1.8	12.6 ± 1.7	0.02	12.5 ± 1.6	12.8 ± 1.7	0.07	12.1 ± 1.1	12.9 ± 1.9	< 0.001
INR	1.1 ± 0.1	1.1 ± 0.1	0.26	1.1 ± 1.1	1.1 ± 1.1	0.79	1.0 ± 0.1	1.1 ± 0.1	0.01
SCr	77.9 ± 21.0	75.9 ± 32.6	0.20	79.5 ± 18.2	80.9 ± 59.5	0.71	78.2 ± 27.6	80.0 ± 21.1	0.49
Child-Pugh class
A	585 (97.0%)	641 (95.5%)	0.16	254 (98.1%)	304 (96.2%)	0.19	155 (100.0%)	181 (97.3%)	0.04
B	18 (3.0%)	30 (0.5%)		5 (1.9%)	12 (3.8%)		0 (0%)	5 (2.7%)
C	0 (0%)	0 (0%)		0 (0%)	0 (0%)		0 (0%)	0 (0%)
Liver cirrhosis			0.10			0.11			0.001
Yes	213 (35.3%)	267 (39.8%)		96 (37.2%)	139 (43.8%)		37 (23.9%)	77 (41.4%)
No	390 (64.7%)	404 (60.2%)		162 (62.8%)	178 (56.2%)		118 (76.1%)	109 (58.6%)

Table 2. Baseline Information of Patients Stratified by Age and Treatment Type After IPTW

65 - 69 years of age after IPTW

70 - 74 years of age after IPTW

≥ 75 years of age after IPTW

Resection (n^a = 603)

Ablation (n^a = 671)

Resection (n^a = 258)

Ablation (n^a = 317)

Resection (n^a = 155)

Ablation (n^a = 186)

^aThe sample size was adjusted because of IPTW. IPTW: inverse probability of treatment weighting; AFP: α-fetoprotein; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; HBV: hepatitis B virus; PLT: platelet; PT: prothrombin time; INR: international normalized ratio; SCr: serum creatinine; TBIL: total bilirubin.

Age

66.5 ± 1.5

66.5 ± 1.4

0.96

71.8 ± 1.4

1.00

77.9 ± 2.8

78.6 ± 3.6

0.07

Sex

0.79

0.40

0.35

Male

496 (82.3%)

548 (81.7%)

199 (76.8%)

252 (79.7%)

131 (84.5%)

150 (80.6%)

Female

107 (17.7%)

123 (18.3%)

60 (23.2%)

64 (20.3%)

24 (15.5%)

36 (19.4%)

Background disease of the liver

0.86

0.27

0.13

HBV infection

380 (63.0%)

436 (64.9%)

136 (52.7%)

181 (57.3%)

73 (47.1%)

103 (55.4%)

Other

223 (37.0%)

236 (35.1%)

122 (47.3%)

135 (42.7%)

82 (52.9%)

83 (44.6%)

Comorbid illness

Hypertension

156 (25.9%)

178 (26.5%)

0.79

81 (31.4%)

132 (41.6%)

0.11

73 (47.1%)

81 (43.8%)

0.54

Diabetes

96 (15.9%)

108 (16.1%)

0.93

53 (20.5%)

61 (19.2%)

0.71

32 (20.6%)

38 (20.5%)

0.98

Heart disease

44 (7.3%)

49 (7.3%)

1.00

26 (10.0%)

46 (14.6%)

0.10

23 (14.8%)

25 (13.5%)

0.73

Tumor size

29.0 ± 11.5

28.4 ± 11.0

0.35

28.8 ± 11.5

29.1 ± 10.3

0.80

30.2 ± 11.5

28.3 ± 10.2

0.11

Tumor count

0.10

0.49

0.03

544 (90.2%)

584 (87.0%)

221 (85.3%)

259 (82.0%)

137 (88.4%)

149 (80.1%)

51 (8.5%)

68 (10.2%)

31 (12.0%)

44 (13.9%)

16 (10.3%)

25 (13.4%)

8 (1.3%)

19 (2.8%)

7 (2.7%)

13 (4.1%)

2 (1.3%)

12 (6.5%)

AFP

0.44

0.26

0.46

< 10

288 (47.7%)

302 (45.0%)

136 (52.7%)

146 (46.1%)

86 (55.5%)

89 (48.1%)

10 - 100

131 (21.7%)

160 (23.8%)

46 (17.8%)

54 (17.0%)

34 (21.9%)

42 (22.7%)

100 - 1,000

110 (18.2%)

137 (20.4%)

52 (20.2%)

75 (23.7%)

18 (11.6%)

31 (16.8%)

> 1,000

75 (12.4%)

72 (10.7%)

24 (9.3%)

42 (13.2%)

17 (11.0%)

23 (12.4%)

ALT

43.1 ± 66.6

43.2 ± 50.5

0.98

33.7 ± 24.1

31.6 ± 26.7

0.32

30.7 ± 20.6

32.9 ± 25.6

0.39

AST

42.6 ± 53.5

42.1 ± 40.4

0.87

37.8 ± 23.6

36.7 ± 28.2

0.63

32.9 ± 16.9

37.7 ± 28.5

0.07

ALB

42.0 ± 15.9

41.3 ± 4.5

0.27

41.0 ± 4.4

40.7 ± 4.8

0.46

41.4 ± 3.5

40.3 ± 4.1

0.01

TBIL

15.9 ± 15.1

15.8 ± 15.2

0.88

15.2 ± 6.6

15.3 ± 8.8

0.89

13.7 ± 5.5

14.9 ± 6.7

0.07

PLT

151.5 ± 64.9

145.4 ± 63.3

0.09

159.0 ± 58.3

158.7 ± 81.5

0.98

152.2 ± 61.4

142.7 ± 58.4

0.14

12.4 ± 1.8

12.6 ± 1.7

0.02

12.5 ± 1.6

12.8 ± 1.7

0.07

12.1 ± 1.1

12.9 ± 1.9

< 0.001

INR

1.1 ± 0.1

0.26

1.1 ± 1.1

0.79

1.0 ± 0.1

1.1 ± 0.1

0.01

SCr

77.9 ± 21.0

75.9 ± 32.6

0.20

79.5 ± 18.2

80.9 ± 59.5

0.71

78.2 ± 27.6

80.0 ± 21.1

0.49

Child-Pugh class

585 (97.0%)

641 (95.5%)

0.16

254 (98.1%)

304 (96.2%)

0.19

155 (100.0%)

181 (97.3%)

0.04

18 (3.0%)

30 (0.5%)

5 (1.9%)

12 (3.8%)

0 (0%)

5 (2.7%)

0 (0%)

Liver cirrhosis

0.10

0.11

0.001

Yes

213 (35.3%)

267 (39.8%)

96 (37.2%)

139 (43.8%)

37 (23.9%)

77 (41.4%)

390 (64.7%)

404 (60.2%)

162 (62.8%)

178 (56.2%)

118 (76.1%)

109 (58.6%)

**Table 3.** Effect of Treatment on Survival Across Age Groups
	Hazard ratio	95% CI	P value	P value for interaction
CI: confidence interval.
Overall survival
Resection vs. ablation (age 65 - 69 years)	0.38	0.28 - 0.50	< 0.001	Reference
Resection vs. ablation (age 70 - 74 years)	0.64	0.45 - 0.91	0.01	0.039
Resection vs. ablation (age ≥ 75 years)	0.84	0.55 - 1.30	0.44	0.002
Recurrence-free survival
Resection vs. ablation (age 65 - 69 years)	0.59	0.51 - 0.70	< 0.001	Reference
Resection vs. ablation (age 70 - 74 years)	0.49	0.37 - 0.64	< 0.001	0.054
Resection vs. ablation (age ≥ 75 years)	0.72	0.52 - 0.99	0.04	0.197

Table 3. Effect of Treatment on Survival Across Age Groups

Hazard ratio

95% CI

P value

P value for interaction

CI: confidence interval.

Overall survival

Resection vs. ablation (age 65 - 69 years)

0.38

0.28 - 0.50

< 0.001

Reference

Resection vs. ablation (age 70 - 74 years)

0.64

0.45 - 0.91

0.01

0.039

Resection vs. ablation (age ≥ 75 years)

0.84

0.55 - 1.30

0.44

0.002

Recurrence-free survival

Resection vs. ablation (age 65 - 69 years)

0.59

0.51 - 0.70

< 0.001

Reference

Resection vs. ablation (age 70 - 74 years)

0.49

0.37 - 0.64

< 0.001

0.054

Resection vs. ablation (age ≥ 75 years)

0.72

0.52 - 0.99

0.04

0.197

**Table 4.** Comparison of Other Related Events Between the Resection and Ablation Group After IPTW
	Resection group	Ablation group	P
^aTotal cost was calculated by adding cost of each hospitalization. ^bTotal in-hospital days was calculated by adding days of each hospitalization. HCC: hepatocellular carcinoma; IPTW: inverse probability of treatment weighting.
Total cost^a for HCC treatment ($)	11,411.62 ± 7,453.18	11,422.80 ± 10,752.22	0.99
Total in-hospital days^b for HCC treatment	19.10 ± 11.68	17.84 ± 18.48	0.45
Total times of hospitalization for HCC treatment	2.15 ± 1.91	3.34 ± 3.72	< 0.001
Surgery time (min)	150.01 ± 71.52	80.64 ± 66.60	< 0.001
Intensive care unit admission			< 0.001
Yes	27.4%	3.8%
No	72.6%	96.2%
Mortality within 30 days	2	2	0.97
Mortality within 90 days	5	4	0.69

Table 4. Comparison of Other Related Events Between the Resection and Ablation Group After IPTW

Resection group

Ablation group

^aTotal cost was calculated by adding cost of each hospitalization. ^bTotal in-hospital days was calculated by adding days of each hospitalization. HCC: hepatocellular carcinoma; IPTW: inverse probability of treatment weighting.

Total cost^a for HCC treatment ($)

11,411.62 ± 7,453.18

11,422.80 ± 10,752.22

0.99

Total in-hospital days^b for HCC treatment

19.10 ± 11.68

17.84 ± 18.48

0.45

Total times of hospitalization for HCC treatment

2.15 ± 1.91

3.34 ± 3.72

< 0.001

Surgery time (min)

150.01 ± 71.52

80.64 ± 66.60

< 0.001

Intensive care unit admission

< 0.001

Yes

27.4%

3.8%

72.6%

96.2%

Mortality within 30 days

0.97

Mortality within 90 days

0.69