Outcomes in elderly patients undergoing hepatic resection compared to ablative therapy for hepatocellular carcinoma

Abstract

Background and ObjectivesHepatic resection is an excellent option in the care of patients with hepatocellular carcinoma (HCC). Elderly patients often forego hepatic resection in favor of liver‐directed ablative therapies due to the increased likelihood of adverse postoperative outcomes due to age. We sought to determine long‐term outcomes in patients who underwent hepatic resection compared to liver‐directed ablative therapy in this patient population.MethodsWe queried the National Cancer Database for elderly patients (≥70 years) diagnosed with HCC between 2004 and 2018. The primary outcome was overall survival (OS) computed using the Kaplan–Meier method and Cox proportional hazard regression.ResultsA total of 10 032 patients were included in this analysis. On unadjusted analysis (p < 0.001) as well as multivariable analysis (hazard ratio: 0.65, 95% confidence interval: 0.57–0.73), hepatic resection was associated with improved OS. The protective association between hepatic resection and OS persisted after 1:1 propensity score matching.ConclusionsHepatic resection is associated with improved survival for well‐selected elderly patients with HCC. While age is often thought of as influencing the decision to offer surgery, our study, in combination with others, demonstrates that it should not. Instead, other objective indicators of performance and functional status may be considered.

Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma

“…Both LR and TA have been shown to be curative in a subset of patients. [13][14][15] However, there is a lack of robust data evaluating their comparative impact on survival for T2 MHCC. In this study, we The NCDB collects data from >1500 institutions accredited by the Commission on Cancer, capturing >70% of cancer diagnoses in the United States annually.…”

“…Both LR and TA have been shown to be curative in a subset of patients 13–15 . However, there is a lack of robust data evaluating their comparative impact on survival for T2 MHCC.…”

Outcomes in elderly patients undergoing hepatic resection compared to liver transplant for hepatocellular carcinoma

“…Henceforth, a good understanding of the surgical options that exist to treat HCC among the elderly is needed. 9 While many studies have evaluated the outcomes of LT and HR individually among the elderly, there is a dearth of literature comparing the outcomes of the two modalities. Therefore, in this study, we aim to compare the HR outcomes to LT among the elderly population with HCC using a large national cancer database (NCDB).…”