Research Paper Volume 16, Issue 11 pp 9824—9845
Age-related nomogram revealed optimal therapeutic option for older patients with primary liver cancer: less is more
- 1 Department of Geriatric Digestive Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- 2 Experimental Teaching Center for Clinical Skills, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
Received: September 15, 2023 Accepted: May 3, 2024 Published: June 6, 2024
https://doi.org/10.18632/aging.205901How to Cite
Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Age bias in therapeutic decisions for older patients with cancer exists. There is a clear need to individualize such decisions.Methods: Based on the Surveillance, Epidemiology and End Results (SEER) database, 5081 primary liver cancer (PLC) patients between 2010 and 2014 were identified and divided into <64, 64-74 and >74 years group. Each group was randomly divided into training and internal validation cohorts, and patients who were diagnosed between 2015 and 2016 were included as an external validation. The nomogram model predicting overall survival (OS) was generated and evaluated based on the Cox regression for the influencing factors in prognosis. The K-M analysis was used to compare the difference among different treatments.Results: KM analysis showed a significant difference for OS in three age groups (P < 0.001). At the same time, we also found different prognostic factors and their importance in different age groups. Therefore, we created three nomograms based on the results of Cox regression results for each age group. The c-index was 0.802, 0.766, 0.781 respectively. The calibration curve and ROC curve show that our model has a good predictive efficacy and the reliability was also confirmed in the internal and external validation set. An available online page was established to simplify and visualize our model (http://124.222.247.135/). The results of treatment analysis revealed that the optimal therapeutic option for PLCs was surgery alone.
Conclusions: The optimal therapeutic option for older PLCs was surgery alone. The generated dynamic nomogram in this study may be a useful tool for personalized clinical decisions.
Abbreviations
PLC: primary liver cancer; SEER: Surveillance, Epidemiology and End Results database; OS: overall survival; HBV: hepatitis B virus; HCV: hepatitis C virus; HCC: hepatocellular carcinoma; ICC: intrahepatic cholangiocarcinoma; AIC: akaike information criterion; AUC: area under curve; DCA: decision curve analysis; ROC: receiver operating characteristic curve; N: no treatment; S: surgery alone; C: chemotherapy alone; R: radiation alone; S+C: surgery combined with chemotherapy; S+R: surgery combined with radiation; C+R: chemotherapy combined with radiation; S+C+R: surgery combined with chemotherapy and radiation.