RESUMEN
We evaluated the post-treatment overall survival (OS) of elderly hepatocellular carcinoma (HCC) patients.The archived records of 10,578 HCC patients registered at the Korean Central Cancer Registry from 2008 through 2014 were retrospectively analyzed. In this registry, we selected Barcelona Clinic Liver Cancer (BCLC) 0, A, or B staged HCC patients (nâ=â4744) treated by surgical resection (SR), local ablation therapy (LAT), or locoregional therapy (LRT). OSs in nonelderly (<70 years) and elderly (≥70 years) patients were compared after propensity score matching (PSM).In BCLC 0-A staged HCC, the cumulative OS rates of elderly patients were poorer than those of nonelderly patients after PSM (Pâ<â.001), but not in those with BCLC stage B (Pâ>â.05). In BCLC 0-A staged elderly patients, OS after SR was significantly better than after LAT (Pâ=â.005) or LRT (Pâ<â.001). In BCLC B staged elderly patients, SR achieved better OS than LRT (Pâ=â.006). Multivariable analysis showed that LAT (hazard ratio [HR] 1.52, Pâ=â.048) or LRT (HR, 2.01, Pâ<â.001) as compared with SR, and large (>3âcm) tumor size (HR1.49, Pâ=â.018) were poor predictors of OS for elderly patients with BCLC stage 0-A, and that LRT (HR, 2.64, Pâ=â.042) was a poor predictor for those with BCLC stage B.SR provided a better OS rate than LAT or LRT in elderly HCC patients with BCLC stage 0-A, than LRT in those with BCLC stage B. SR should be considered the first therapeutic option even in elderly HCC patients with these stages.
Asunto(s)
Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Ablación por Catéter/estadística & datos numéricos , Quimioembolización Terapéutica/estadística & datos numéricos , Comorbilidad , Femenino , Conductas Relacionadas con la Salud , Hepatectomía/estadística & datos numéricos , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Pruebas de Función Hepática , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Estadificación de Neoplasias , Puntaje de Propensión , Sistema de Registros , República de Corea/epidemiología , Estudios Retrospectivos , Factores Sexuales , Factores Socioeconómicos , Análisis de Supervivencia , Carga TumoralRESUMEN
PURPOSE: The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance. MATERIALS AND METHODS: We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions. RESULTS: The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important. CONCLUSION: The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.