Clinical features of hepatocellular carcinoma in the elderly: a study of 91 patients older than 70 years

Nomura, Fumio; Ohnishi, Kunihiko; Honda, Michitaka; Satomura, Yoshitake; Nakai, Takaaki; Okuda, Kunio

doi:10.1038/bjc.1994.374

Cited by 45 publications

(36 citation statements)

References 15 publications

(7 reference statements)

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“…According to their age at the time of surgery, these patients were divided into two groups, that is, 333 patients <70 years old and 155 patients !70 years old (including 20 patients aged !80 years). The patients aged !70 years were defined as elderly [14,22,23]. None of the patients in either group received postoperative adjuvant therapy before recurrence was detected.…”

Section: Patientsmentioning

confidence: 99%

“…Therefore, resection is considered to be a reasonable first-line treatment for patients with small tumors and underlying chronic liver disease. Recent studies have identified some differences in the clinicopathological features of HCC between elderly patients and younger patients [14,15], and some authors have found significantly higher morbidity and mortality rates after hepatectomy for HCC in the elderly [16][17][18]. With improved surgical techniques, better perioperative assessment, and advances in anesthesia and medical care, other authors have reported that liver resection is a relatively safe procedure even in older patients [19][20][21].…”

Section: Introductionmentioning

confidence: 98%

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Hepatic resection for hepatocellular carcinoma in the elderly

Kaibori

Matsui

Ishizaki

et al. 2009

Journal of Surgical Oncology

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Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Hepatic resection for hepatocellular carcinoma in the elderly

Kaibori

Matsui

Ishizaki

et al. 2009

Journal of Surgical Oncology

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“…Most patient characteristics were homogeneously distributed between younger and older patients, but the elderly patients had significantly lower hepatitis B (HBV) and higher hepatitis C (HCV) infection rates, as well as higher proportions of female patients (Tables 2, 3) suggesting a different hepato-carcinogenesis in geriatric patients [28,29].…”

Section: Liver Resection For Hepatocellular Carcinomamentioning

confidence: 99%

Should We Deny Surgery for Malignant Hepato‐Pancreatico‐Biliary Tumors to Elderly Patients?

Petrowsky

Clavien

2005

World j. surg.

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Abstract. Malignant hepato-pancreatico-biliary (HPB) tumors have their highest incidence within the sixth to eighth decades of life. The aging of the world population has resulted in a dramatic increase in the number of elderly patients considered for resection of malignant HPB tumors. Because elderly patients are more likely to have more co-morbidities, cognitive impairment, and decreased life expectancy, the benefit and appropriateness of these procedures must be scrutinized for geriatric patients. Therefore, many surgeons have compared the perioperative and long-term outcome of hepatic and pancreatic resections for elderly and younger patients. In most series the elderly population was defined by an age of 70 years or older. The results demonstrate that hepatic resection for hepatocellular carcinoma and colorectal liver metastases can be safely performed in well-selected elderly patients with long-term outcome comparable to younger patients. Similar findings are also reported for pancreatic resection in elderly patients with either ampullary or pancreatic cancer. Although the survival benefit of pancreatico-duodenectomy is limited in all age groups, the absence of competitive therapy justifies this procedure as the sole curative option in younger as well as older patients. Data on resection of gallbladder cancer and hilar bile duct cancer in the elderly are sparse, but there is evidence from large series on resection of these types of tumors that advanced age per se is not a risk factor for reduced outcome. Therefore, surgical options should not be denied to elderly patients with a malignant HPB tumor, and the evaluation should include surgeons expert in HPB surgery.

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“…In general, the chronological age of 65 years-roughly equivalent to retirement age -is currently accepted as a threshold to define an "elderly" person. In scientific literature on liver disease, and in particular in papers dealing with HCC, the most used threshold is 70 years [21][22][23] . More recently, clinical studies adopting a threshold of 75/80 years have been published [24][25][26] .…”

Section: Implicationmentioning

confidence: 99%

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under-or no-treatment of aged patients should not be longer justified. Core tip: The number of elderly patients with cancer is expected to rise in the next future, and facing with elderly cirrhotic patients with hepatocellular carcinoma (HCC) will characterize liver oncology scenario in the near future. International guidelines do not specifically address how to approach HCC in aged patients and no recommendations are available on age threshold to which clinical decisions should refer. Available data seem to rule out an intrinsic negative impact of age itself on HCC prognosis, and treatment allocation should be decided mainly according to HCC stage, liver residual function and general conditions. Indeed, a nihilistic AbstractMean age of hepatocellular carcinoma (HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific REVIEWSubmit a

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Clinical features of hepatocellular carcinoma in the elderly: a study of 91 patients older than 70 years

Cited by 45 publications

References 15 publications

Hepatic resection for hepatocellular carcinoma in the elderly

Hepatic resection for hepatocellular carcinoma in the elderly

Should We Deny Surgery for Malignant Hepato‐Pancreatico‐Biliary Tumors to Elderly Patients?

Management of hepatocellular carcinoma in the elderly

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