Analysis Of Treatment With Hepatic Resection Or Radiofrequency Ablation For Elderly Patients With Hepatocellular Carcinoma Within Milan Criteria Using Decision Tree Models

Part One.Risk Factor Analysis of Complications and Overall Survival of Elderly Patients with Hepatocellular Carcinoma within Milan Criteria After Receiving TreatmentBackground As the life expectancy of population is getting longer and public health become more general,the incidence of HCC within Milan criteria rises in the elderly.We are facing several kinds of treatment for elderly HCC patients within Milan criteria and taking multiple risk factors into account,which are mainly about clinical serious complication and overall survival after treatment.We should found out the risk factor at first before establishing the decision tree models.Method We retrospectively collected the data of a cohort of 639 consecutive elderly Milan criteria(single HCC 5 cm or up to 3 nodules each < 3 cm)HCC patients who received hepatice resection and radiofrequency ablation between Jan.2008 and Dec.2010 at Hepatic Surgery of the Eastern Hepatobiliary Hospital(EHBH).The complication and survival after treatment were analysed by SPSS 20.0.Results For 639 patients,independent risk fators of serious complications after treatment through Logistics regression analysis were age >68 years,Child-Pugh grade B,cirrhosis,diameter > 3cm,multiple nodules and hepatice resection,and they all had significant difference(P<0.05);Independent risk fators of overall survival after treatment via Cox regression analysis were Child-Pugh grade B,cirrhosis,performance status >1,diameter > 3cm and multiple nodules,and they all had significant difference(P<0.05)Conclusion The significant 7 factors of options for elderly early HCC were age >68 years,Child-Pugh grade B,cirrhosis,performance status >1,diameter > 3cm,multiple nodules and treatment type.Part Two.The Decision Tree of Treatment with Hepatic Resection or Radiofrequency Ablation for Elderly Patients with Hepatocellular Carcinoma within Milan CriteriaAim As the life expectancy of population is getting longer and public health become more general,the incidence of HCC within Milan criteria rises in the elderly.When we are facing elderly HCC within Milan criteria,it is still controversial to choose which one better,hepatic resection or radiofrequency ablation.We aimed to establish the decision tree to solve this problem.Method We used the 6 factors from first part as independent variable and treatment type as dependent variable.The classification tree of options for treatment of elderly patients with early HCC was conducted with rpart and party packages in R project.Results After conducting the classification tree,we got these terminal node: 1)HCC patients with diameter ? 3cm were 363 patients,and Hepatic resection and radiofrequency ablation was 59% and 41%,respectively;2)HCC patients with diameter > 3cm,performance status ?1 were 173 patients,and Hepatic resection and radiofrequency ablation was 85% and 15%,respectively;3)HCC patients with diameter > 3cm,performance status >1,age ? 68 years were 59 patients,and Hepatic resection and radiofrequency ablation was 76% and 15%,respectively;4)HCC patients with diameter > 3cm,performance status >1,age > 68 years and cirrhosis were 11 patients,and Hepatic resection and radiofrequency ablation was 90% and 10%,respectively;5)HCC patients with diameter > 3cm,performance status >1,age > 68 years and cirrhosis were 33 patients,and Hepatic resection and radiofrequency ablation was 18% and 82%,respectively.In the subgroup analysis,1year,3 year,5 year survival rate of elderly patients with diameter ? 3cm was 98.6%,79.7%,60.4% for hepatic resection group;93.9%,74.7%,54.8% for radiofrequency ablation group(P=0.003).Conclusion The options of treatment for elderly HCC patients within Milan criteria should consider 4 factors: tumor diameter,performance status,age,cirrhosis.For elderly HCC patients with tumor diameter ? 3cm,RFA will be better;For elderly HCC patients with tumor diameter > 3cm and PS score ? 1,hepatic resection will get the better prognosis;For elderly HCC patients with tumor diameter > 3cm,PS score > 1 and age ? 68,we recommend treatment with hepatic resection;For elderly HCC patients with tumor diameter > 3cm,PS score > 1,age > 68 and with or without cirrhosis,RFA is the more safe and effective than hepatic resection.