A Review of Hepatocellular Carcinoma in Elderly Patients Focused on Management and Outcomes

Abstract

Recent studies report a significant age-specific increase in hepatocellular carcinoma (HCC) development among persons over 75 years old. Therefore, there is an urgent need to determine the optimal treatment strategy in elderly patients with HCC. This systemic review examines the clinical characteristics, efficacy, and safety of first-line treatment modalities. The literature was searched regarding epidemiology and clinical outcomes in elderly patients (age ≥75 years) undergoing first-line treatment for HCC. Causative or comorbid conditions of HCC in elderly patients differed from those in younger patients. Radiofrequency ablation may be effective and safe in early stages. Surgical resection may also be feasible in the early stages for selected patients. Transarterial chemoembolization may be safe and effective for intermediate HCC, and sorafenib may be feasible in elderly patients with advanced HCC. Prospective randomized trials are needed to establish the treatment strategy for elderly patients with HCC.

Microwave ablation of hepatocellular carcinomas in octogenarians

“…This is well in line with previous findings by Shen et al [10] and Zhang et al [11] offering a potentially curative treatment for octogenarians not deemed fit for surgical resection or as a first-line therapy. Survival in the presented cohort is well comparable to results presented in a meta-analysis of elderly patients resected for HCC by Cho et al [6] , but with much shorter length of stay and much fewer complications, where, typically, resected elderly patients stay for 9-18 days in hospital and with 13%-36% having postoperative complications. In a US study from 2012 on RFA [19] , the postoperative mortality was worse, as was survival with 72% surviving the first year and 39% and 34% at three and five years compared to the present study's 100%, 69% and 40%, respectively, for the octogenarian group, numbers that are somewhat inferior to what Takahashi et al [20] presented.…”

“…Leal et al [5] investigated the impact of liver resection for colorectal liver metastases on octogenarians compared to younger patients in a matched cohort study and found twice the morbidity (19% vs. 9%) and a 90-day mortality of 7% vs. 0%. In a recent review by Cho et al [6] , curative intended treatments for hepatocellular cancer with resection or radiofrequency ablation (RFA) was found to be safe in selected patients over the age of 75 [5] , namely patients who generally had less severe underlying liver disease, were predominantly female and had more well-differentiated tumours, indicating that there was a clear selection bias when comparing the elderly with younger HCC patients. With careful selection, excellent results of resection can be achieved [7][8][9] .…”

Ramucirumab in elderly patients with hepatocellular carcinoma and elevated alpha‐fetoprotein after sorafenib in REACH and REACH‐2

“…Treatment of elderly patients with HCC remains an unresolved clinical challenge, with increasing unmet need, especially for those ≥70 years of age. [4][5][6] Despite recently available data supporting the efficacy of multitargeted tyrosine kinase inhibitors (mTKIs), [4][5][6][7][8][9] single-agent immune checkpoint inhibitors (CPI) 10,11 or CPI in combination with an anti-angiogenic agent, 12 data for elderly patients are scarce. Of note, where data are available, the use of mTKIs is associated with significant adverse effects 4,6,13 or unknown toxicity profiles 8,9 in this population.…”

<p>Long-Term Survival in Patients Receiving Combination Therapy with Resection and Radiofrequency Ablation for Multi-Focal Hepatocellular Carcinoma Classified as Barcelona Clinic Liver Cancer Stage B: A Retrospective Controlled Study</p>

“…In the treatment of repeatedly recurring intrahepatic tumors, RFA has the advantages of being safe, effective, repeatable and minimally invasive. 22,23 The application of IOUS must be emphasized. Preoperative imaging techniques may miss small tumors in the liver.…”