title: Cause-specific mortality associated with aging in patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation.
abstract: OBJECTIVE
  The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is expected to increase. The aim of this study is to evaluate the efficacy of radiofrequency ablation (RFA) in elderly patients with HCC and to investigate cause-specific excess deaths associated with increasing number of elderly patients.
  
  
  METHODS
  We enrolled 1401 naive patients with HCC who were treated initially by RFA from 1999 to 2011. Patients below 75 years of age were categorized as 'younger' and those at least 75 as 'elderly'. Differences in the demographic and laboratory data of these patients were assessed, along with Kaplan-Meier analysis of survival using the log-rank test. In addition, we assessed the causes of death, defined as liver related and liver unrelated, by competing risk analysis and risk factors for respective causes of death by a proportional subdistribution model.
  
  
  RESULTS
  Overall, 353 patients were categorized as elderly. Elderly patients were more likely to be women, infected with hepatitis C virus, and score better in the Child-Pugh classification. The mortality at 5 years was lower in the elderly than in the younger patients (47.3 vs. 37.1%; P<0.001). Competing risk analysis showed a significant difference in liver-unrelated death (P<0.001) between the two groups, whereas there were no significant differences in liver-related death (P=0.64). By the proportional subdistribution model, age was a significant risk factor only for liver-unrelated death.
  
  
  CONCLUSIONS
  RFA provided satisfactory 5-year survival rates in elderly patients with HCC. The elderly tended to die from liver-unrelated causes.
authors: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Naoto
authors: N
authors: Fujiwara
authors: Ryosuke
authors: R
authors: Tateishi
authors: Mayuko
authors: M
authors: Kondo
authors: Tatsuya
authors: T
authors: Minami
authors: Shintaro
authors: S
authors: Mikami
authors: Masaya
authors: M
authors: Sato
authors: Koji
authors: K
authors: Uchino
authors: Kenichiro
authors: K
authors: Enooku
authors: Ryota
authors: R
authors: Masuzaki
authors: Hayato
authors: H
authors: Nakagawa
authors: Yuji
authors: Y
authors: Kondo
authors: Yoshinari
authors: Y
authors: Asaoka
authors: Shuichiro
authors: S
authors: Shiina
authors: Haruhiko
authors: H
authors: Yoshida
authors: Kazuhiko
authors: K
authors: Koike
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome