Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience.
OBJECTIVE
The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is expected to increase. We compared the presenting features and outcome of HCC in elderly (>or=70 years) and younger patients (<70 years).


METHODS
Multicentre retrospective cohort study and nested case-control study. Patients 614 elderly and 1104 younger patients from the ITA.LI.CA database, including 1834 HCC cases consecutively diagnosed from January 1987 to December 2004. Both groups were stratified according to treatment: hepatic resection, percutaneous procedures, transarterial chemoembolisation (TACE). Survival was assessed in the whole population and in each treatment subgroup. Age, sex, aetiology, cirrhosis, comorbidities and cancer stage (CLIP score) were tested as predictors of survival. In each subgroup, differences in patient survival were also assessed after adjustment and matching by propensity score.


RESULTS
Ageing was associated with a higher prevalence of comorbidities, better liver function and CLIP score. Regardless of age, two-thirds of patients underwent radical treatments or TACE. Elderly patients underwent more ablative procedures and fewer resections or TACE sessions. The survival of elderly and younger patients was comparable in each treatment subset, and was predicted by CLIP score. This result was confirmed by the propensity analysis.


CONCLUSIONS
The overall applicability of radical or effective HCC treatments was unaffected by old age. However, treatment distribution differed, elderly individuals being more frequently treated with percutaneous procedures and less frequently with resection or TACE. Survival was unaffected by age and primarily predicted by cancer stage, assessed by the CLIP system, both in the overall population and in treatment subgroups.
Mirici-Cappa
Federica
F
Dipartimento di Medicina Clinica, Alma Mater Studiorum-Università di Bologna, Semeiotica Medica, via Albertoni 15, Bologna 40138, Italy.
Gramenzi
Annagiulia
A
Santi
Valentina
V
Zambruni
Andrea
A
Di Micoli
Antonio
A
Frigerio
Marta
M
Maraldi
Francesca
F
Di Nolfo
Maria Anna
MA
Del Poggio
Paolo
P
Benvegnù
Luisa
L
Rapaccini
Gianludovico
G
Farinati
Fabio
F
Zoli
Marco
M
Borzio
Franco
F
Giannini
Edoardo Giovanni
EG
Caturelli
Eugenio
E
Bernardi
Mauro
M
Trevisani
Franco
F
D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D004812:Epidemiologic Methods; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome