J Liver Cancer.  2023 Sep;23(2):362-376. 10.17998/jlc.2023.08.03.

The efficacy of treatment for hepatocellular carcinoma in elderly patients

• Lee HA
• Lee S
• Lee HL
• Song JE
• Lee DH
• Han S
• Shim JH
• Kim BH
• Choi JY
• Rhim H
• Kim DY

• KMID: 2546416
• DOI: http://doi.org/10.17998/jlc.2023.08.03

Abstract

Background
/Aim: Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Methods
Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Results
Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Conclusions
Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.

Keyword

Aged; General surgery; Local ablation; Transarterial therapy; Systemic therapy

Figure

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  Figure 1. Change in proportion of elderly patients in entire hepatocellular carcinoma population.

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  Figure 2. Overall survival in (A) elderly and non-elderly patients, and (B) elderly patients with and without treatment for hepatocellular carcinoma.

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  Figure 3. Overall survival of elderly and non-elderly patients in early-stage hepatocellular carcinoma treated with surgery, local ablation therapy, and transarterial therapy before (A, C, E) and after IPTW (B, D, F). IPTW, inverse probability of treatment weighting.

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  Figure 4. Overall survival of elderly and non-elderly patients in intermediate-stage hepatocellular carcinoma treated with surgery and transarterial therapy before (A, C) and after IPTW (B, D). IPTW, inverse probability of treatment weighting.

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  Figure 5. Overall survival of elderly and non-elderly patients in advanced-stage hepatocellular carcinoma treated with transarterial and systemic therapy before (A, C) and after IPTW (B, D). IPTW, inverse probability of treatment weighting.

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Reference

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