Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults

Abstract

The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is expected to increase. The present study aims to evaluate the role of age on treatments and outcome of HCC patients. 1530 patients firstly diagnosed with HCC were retrospectively included and classified as older (≥65 years, n = 318, 21%) and younger patients (<65 years, n = 1212, 79%). The two groups were compared with clinical characteristics, tumor burden, Barcelona Clinics Liver Cancer (BCLC) stage, treatments and long-term prognosis. Elderly patients were more HCV infected, had more diabetes, poorer performance status, and were less aggressively treated. The proportion of HCC within BCLC stage 0-A, B or C was similar between the two groups, but elderly patients were more presented with BCLC stage D. The overall survival of older patients was poorer compared to younger patients before and after propensity score matching. However, elderly patients were less often effectively treated with surgery and loco-regional therapies across different BCLC stages. After stratified by BCLC stages or treatments, older patients showed comparable long-term outcome to younger patients. Performance status, BCLC stages and effective treatments, rather than age, was independent factors determining prognosis in the whole cohort and only elderly patients by multivariate analysis. In conclusion, older could have comparable survival to younger patients within the same tumor stage or after similar treatments. Thus, equally active treatments should be encouraged to elderly patients.

Prognoses, outcomes and clinicopathological characteristics of very elderly patients with hepatocellular carcinoma who underwent hepatectomy

“…This rate was high. Previous studies have reported that the number of elderly patients with HCC is increasing [20] and that elderly patients have higher rates of HCV or NBNC than nonelderly patients [14,15,20,21], which is consistent with our results. HCV infections generally occur in adulthood, in contrast to HBV infections, which are generally acquired through mother-child transmission [22].…”

“…In contrast, gastric [11], colorectal [12], and breast [13] cancers show poorer prognoses in young patients than in elderly patients. There have been some reports concerning HCC; however, the conclusions of these reports are controversial [14,15].…”

“…The prognoses of pretty elderly patients with HCC are under investigation. Many reports have claimed that the prognoses after hepatectomy are not different between elderly patients and nonelderly patients[15,20,26]. Oishi et al reviewed 23 papers and reported that the 5-year OS rates after hepatectomy in elderly HCC patients ranged from 26-75.9%, whereas those in young patients ranged from 31.4-68%.…”

Outcome of a second hepatectomy in octogenarians with hepatocellular carcinoma recurrence: single centre's experience

“…While a number of tools for evaluating the operative indications have been developed, including the APACHE score and E‐PASS score, elderly patients are selected for surgery based on the same criteria as young patients in our centre. In general, elderly patients who undergo operations tend to have more comorbidities than young patients, such as hepatitis C viral (HCV) infection, respiratory disease and diabetes, and they also have a poor performance status . Regarding HCV infection, elderly patients have shown a poor response to interferon therapy due to severe side effects or insufficient compliance with drug intake.…”

“…More elderly patients receive non‐surgical therapies than young patients, even if their HCC is operable. Hui et al . showed that elderly patients (≥65 years of age) were less often effectively treated with surgery and loco‐regional therapies across different Barcelona Clinic Liver Cancer (BCLC) stages than younger patients.…”