Clinical outcome in elderly Chinese patients with primary hepatocellular carcinoma treated with percutaneous microwave coagulation therapy (PMCT)

Abstract

Percutaneous microwave ablation therapy (PMCT) has been recommended for elderly hepatocellular carcinoma (HCC) patients who cannot tolerate surgery due to their age or presence of comorbidities. Few studies have investigated efficacy and treatment outcomes for PMCT treatment in these patients, especially in China, where patients are more often diagnosed and treated early in life. This study evaluated the safety and efficacy of ultrasound-guided PMCT in treatment-naive elderly HCC patients, and analyzed risk factors associated with poor treatment outcomes.The 65 HCC patients in this retrospective study were divided into 2 groups: <65 years old or ≥65 years old. Patients received PMCT every month until tumor was unobservable and were then followed for 1 month after ablation. The primary clinical endpoint was the rate of complete tumor ablation, and secondary endpoints were progression-free survival and overall survival.Patients ≥65 years old had significantly poorer performance status than younger patients, but similar rates of complete ablation. Multiple tumors and hypertension were associated with a significantly higher risk of death, while higher postoperative alanine aminotransferase levels were associated with a significantly lower risk of death. Patients with tumor sizes >5 to ≤ 10 cm were at a significantly higher risk for disease progression than patients with tumor sizes >1 to ≤ 3 cm. Complete ablation significantly lowered the risk of disease progression.PMCT is safe and effective for patients ≥65 years of age, achieving total ablation in more than 90% of patients. Age and comorbidities did not affect clinical outcome.

Microwave ablation of hepatocellular carcinomas in octogenarians

“…The presented data show that microwave ablation of HCC in selected octogenarians can be performed with low morbidity and with results that are equal to those for septuagenarians, which was the primary aim of the study. 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.…”

“…With careful selection, excellent results of resection can be achieved [7][8][9] . However, with increasing age, comorbidities amass and resective surgery is often not deemed appropriate and patients can be offered local ablative treatments with RFA instead without having age or comorbidities affecting outcome [10,11] . In a recent publication, octogenarians undergoing stereotactic RFA for primary liver tumours were compared to a younger control group using propensity score matching and no significant differences in terms of local recurrence, major complications and overall survival were found [12] .…”

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

“…One study that reported clinical outcomes after microwave ablation suggested this treatment option is safe and effective for older patients with HCC (>65 years) (48). However, as far as we are aware, there are no data on microwave ablation treatment in elderly patients with HCC aged 75 years or older.…”

Nomograms to predict survival outcomes after microwave ablation in elderly patients (>65 years old) with early-stage hepatocellular carcinoma

“…Accordingly, new therapeutic modalities for the treatment of HCC continue to appear annually, including local radical ablation, targeted chemotherapeutic agents and radiation therapy [8]. As a main choice for local radical ablation, the benefits of microwave ablation (MWA) include an increased intratumoral temperature and a short operation time, making it as safe and effective in older patients as it is in younger patients [9][10][11][12]. However, it is unclear whether MWA improves long-time survival in elderly patients.…”