title: Early stage hepatocellular carcinoma in the elderly: A SEER database analysis.
abstract: BACKGROUND
  Scarce evidence exists regarding the management of elderly patients (≥70years) with hepatocellular carcinoma (HCC). This study assessed the presentation and outcomes of elderly patients with early stage HCC.
  
  
  METHODS
  Patient with early stage HCC (T1/T2N0M0), ≥70years, diagnosed between 2004 and 2013 were identified from the SEER (Surveillance, Epidemiology, and End Results) database. Propensity score matching (for receipt of localized treatment) was performed considering baseline characteristics (age, gender, race, tumor (T) stage, tumor size, fibrosis score, alpha fetoprotein level and histological subtype).
  
  
  RESULTS
  A total of 6693 patients were identified. The median age group was 75-80years, and 2457 patients received local treatment (either surgical or non-surgical treatment). Both before and after propensity score matching, cancer-specific and overall survival (P<0.0001 for all) were better in the local treatment group. When stratifying the overall survival according to age group (70-80years vs. >80years) in the post matching cohort, patients treated with local treatment have better overall survival than those not treated regardless of the age group (P<0.0001 for both groups). In multivariate analysis of the matched population: local treatment, normal AFP and age (70-80years) were associated with better overall survival (P<0.0001, P<0.0001, P=0.047; respectively).
  
  
  CONCLUSIONS
  Within the known limitations of the current SEER analysis, it may be cautiously suggested that elderly patients with early HCC should be properly selected for potentially curative local therapies. Prospective confirmation of these results should be conducted.
authors.affiliation: Swiss Cancer Institute, Cham, Switzerland; Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Hani
authors.initials: H
authors.lastname: Oweira
authors.affiliation: OncoCentrum Zurich, Swiss Tumor Immunology Institute (SwissTII), Zurich, Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Petrausch
authors.affiliation: Gastrointestinal Tumor Center Zurich (GITZ), Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Helbling
authors.affiliation: Surgical Center Zurich - Hirslanden Hospital Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: Department of Oncology, Center of Zug, Switzerland.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Mannhart
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.affiliation: Surgical Center Zurich - Hirslanden Hospital Zurich, Switzerland.
authors.forename: Othmar
authors.initials: O
authors.lastname: Schöb
authors.affiliation: Swiss Cancer Institute, Cham, Switzerland.
authors.forename: Anwar
authors.initials: A
authors.lastname: Giryes
authors.affiliation: Swiss Cancer Institute, Cham, Switzerland; Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: omar.abdelrhman@med.asu.edu.eg.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdel-Rahman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D057216:Propensity Score; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: HCC; Hepatocellular carcinoma; Local treatment; Surgery