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  • From 2008 to 2013, 1530 adult patients (≥ 18 years) firstly diagnosed with HCC in the largest tertiary hospital in Northwest China were included with intact clinical information and continuous follow-up. The diagnosis of HCC was made by computed tomography scan, ultrasonography, magnetic resonance image and/or angiography preoperatively, and confirmed by histopathological examination of the resected specimen postoperatively if available. The patients were divided into two groups according to the age at admission: the younger (<65 years) and older group (≥65 years). Tumor status was evaluated by imaging studies, and pathological examination if available. Barcelona Clinic Liver Cancer (BCLC) system was used as the optimal staging system in the present study. Since tumor size is a critical factor determining treatment outcome, we and others recommended single tumor larger than 5 cm should be classified as BCLC stage B [18, 19]. Surgical resection was the first-line treatment for patients with BCLC stage A and B after evaluation of tumor size, liver function, remnant liver volume, patient general condition and willingness. Patients with unresectable tumor or unwillingness of surgical treatment would receive loco-regional treatments (LRT), including palliative radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and percutaneous ethanol injection (PEI). However, RFA treatment of HCC within BCLC stage 0-A was recognized as curative treatment and therefore separated from LRT group. Those refusing any invasive treatments might be treated with best supportive treatment (BST). This study has been approved by the ethics committee of Xi’an Jiaotong University and The First Affiliated Hospital. A waiver of informed consent was obtained, since the data were analyzed from the electronic medical record and reported without personal identifiers. Numerical data was expressed as median and range, and compared by Mann-Whitney U test or t tests, whereas nominal variables were expressed as number and percentages and compared by Chi-Square test or Fisher’s exact test. The overall survival rates were calculated by the Kaplan-Meier method, and the differences in survival between groups were compared using the log-rank test. Multivariate analysis was performed and hazard ratio (HR) and 95% coincidence interval (CI) were calculated with forward stepwise Cox proportional hazard regression analysis. Statistical analysis was carried out using SPSS 22.0. p<0.05 was considered statistically significant. To eliminate the selection bias, we introduced PSM analysis into the present study to balance the baseline differences of the groups and thereby simulate random group allocation [20]. 1:1 matching without replacement was performed using a caliper with a width 0.01 of the standard deviation to generate matched pairs of the patients.
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