Prognostic Analysis of Elderly Patients with Hepatocellular Carcinoma: an Exploration and Machine Learning Model Prediction Based on Age Stratification and Surgical Approach
Chiyu Cai1, Hengli Zhu1, Bingyao Li2
1Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, Henan, People's Republic of China.
Purpose:
As the global population ages, precise prognostic tools are needed to optimize postoperative care for elderly hepatocellular carcinoma (HCC) patients. This study established a machine learning-driven predictive model to identify key prognostic determinants and evaluate age/surgical approach impacts, overcoming limitations of traditional statistical methods.
Methods:
This retrospective study included 252 postoperative HCC patients aged ≥65 years (mean age 69.0±4.3; 68.25% male). Patients were randomly divided into training (70%, n=177) and validation sets (30%, n=75). We evaluated 147 machine learning models to establish the optimal predictive model. Patients were grouped by age (>75 vs ≤75 years) and surgical approach (laparoscopic vs open).
Results:
The LASSO+RSF model showed strong predictive performance with AUC values of 0.869 and 0.818 in the training and validation sets, respectively. Time-dependent AUCs for 1-, 2- and 3-year survival were 0.874, 0.903, and 0.883 in the training set, and 0.878, 0.882, and 0.915 in the validation set. Key predictors included age-adjusted Charlson index (ACCI, LASSO+RSF synergistic weight (LRSW) =0.160), microvascular invasion (0.111), tumor capsule integrity (0.034), and lymphatic invasion (0.023), while three variables (intraoperative blood loss, tumor margin, WBC) were excluded (LRSW<0.01). A web-based dynamic nomogram (https://cliniometrics.shinyapps.io/LRSF-GeroHCC/) enabled real-time risk stratification. Patients >75 years had longer length of stay (16 vs 14 days, P=0.033), higher Clavien-Dindo scores (P=0.014), higher ACCI scores (5.5 vs 4.0, P=0.002), and lower PFS (16.5 vs 24 months, P=0.041). Laparoscopic surgery was associated with longer operative time (202.5 vs 159.0min, P<0.001), shorter length of stay (14 vs 17days, P<0.001), and lower Clavien-Dindo scores (P=0.038).
Conclusion:
The LASSO+RSF model provides validated tools for personalized prognosis management in elderly HCC patients, emphasizing age-adapted surgical strategies and comorbidity-focused perioperative care.
