Management and prognosis of hepatocellular carcinoma in the elderly: Results of an in‐field multicenter cohort study

Borzio, Mauro; Dionigi, Elena; Vitale, Alessandro; Rossini, Angelo; Marignani, Massimo; Fornari, Fabio; Vicari, Susanna; Sio, Ilario de; Farinati, Fabio; Bertolini, Emanuela; Oliveri, Filippo; Leandro, Gioacchino; Francica, Giampiero; Mitra, Mario; Omazzi, Barbara; Boccia, S.; Salmi, Andrea; Toldi, Anna; Sacco, Rodolfo

doi:10.1111/liv.13392

Cited by 15 publications

(18 citation statements)

References 41 publications

(91 reference statements)

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“…ECOG score and tumor stages should be the most important factors considered rather than age for treatment selection in elderly patients. These findings were consistent with some other studies that surgical resection and some non-surgical treatments attained the equivalent long-term survival in older with younger patients [ 10 , 14 , 15 , 21 , 22 ] ( Table 5 ). Therefore, older patients can have comparable long-term outcome to younger patients when appropriately selected and treated.…”

Section: Discussionsupporting

confidence: 93%

“…However, the proportion of HCC within BCLC stages 0-A, B and C were similar distributed between older and younger patients. Consistently, some studies found similar tumor stages between older and younger patients with HCC [ 10 , 14 , 15 , 25 ], but others reported earlier tumor stages in elderly patients [ 16 , 21 , 26 ] ( Table 5 ). Thus, the discrepancy of tumor stages between older and younger patients must reflect the difference of patient inclusion and treatment indication of elderly patients in different institutions.…”

Section: Discussionsupporting

confidence: 69%

“…First, older patients with HCC were more likely to be HCV carriers, while younger patients were more HBV carriers. This finding may be explained that HBV is transmitted vertically in the perinatal period, whereas HCV is more infected at a later stage in life, and therefore patients with HBV-related HCC tended to be significantly younger than patients with HCV-related HCC [ 10 , 14 , 15 , 21 , 22 ]. Therefore, the average time at onset of HBV-related HCC was reported to be at least 10 years earlier than that of HCV-related HCC [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults

Guo

et al. 2017

PLoS ONE

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The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is expected to increase. The present study aims to evaluate the role of age on treatments and outcome of HCC patients. 1530 patients firstly diagnosed with HCC were retrospectively included and classified as older (≥65 years, n = 318, 21%) and younger patients (<65 years, n = 1212, 79%). The two groups were compared with clinical characteristics, tumor burden, Barcelona Clinics Liver Cancer (BCLC) stage, treatments and long-term prognosis. Elderly patients were more HCV infected, had more diabetes, poorer performance status, and were less aggressively treated. The proportion of HCC within BCLC stage 0-A, B or C was similar between the two groups, but elderly patients were more presented with BCLC stage D. The overall survival of older patients was poorer compared to younger patients before and after propensity score matching. However, elderly patients were less often effectively treated with surgery and loco-regional therapies across different BCLC stages. After stratified by BCLC stages or treatments, older patients showed comparable long-term outcome to younger patients. Performance status, BCLC stages and effective treatments, rather than age, was independent factors determining prognosis in the whole cohort and only elderly patients by multivariate analysis. In conclusion, older could have comparable survival to younger patients within the same tumor stage or after similar treatments. Thus, equally active treatments should be encouraged to elderly patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults

Guo

et al. 2017

PLoS ONE

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“…This finding may be explained that HBV is transmitted vertically in the perinatal period, whereas HCV is more infected at a later stage in life, and therefore, patients with HBV-related HCC tended to be significantly younger than patients with HCV-related HCC. 10 Our data showed that chronic viral hepatitis was the major risk factor contributing to the development of HCC and majority were males. This study revealed that HCC was more prevalent in males, which is in agreement with previous studies, 16,17 as well as other local and regional studies.…”

Section: Discussionmentioning

confidence: 58%

“…It was found that HBV‐related HCC was mostly found in 41‐60 years old, while HCV‐related HCC was mostly in ≥61 years old. This finding may be explained that HBV is transmitted vertically in the perinatal period, whereas HCV is more infected at a later stage in life, and therefore, patients with HBV‐related HCC tended to be significantly younger than patients with HCV‐related HCC …”

Section: Discussionmentioning

confidence: 98%

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

Zhao

Zhu

Han

et al. 2019

Clinical Laboratory Analysis

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Objective To determine the clinical and liver stiffness characteristics of a cohort of Chinese patients with Hepatocellular carcinoma in different stages of Barcelona clinic liver cancer. Methods Details of 1180 patients with Hepatocellular carcinoma referred from October 2014 to November 2017 were collected retrospectively. Demographic data, etiology, clinical, and biochemical details were retrospectively analyzed. The changes of liver stiffness in different etiologies and different stages of Barcelona clinic liver cancer were especially analyzed. Results The onset age was 60.33 ± 9.11 (range 24‐84) years, 9 cases were ≤40 years, 572 cases were 41‐60 years, males accounted for 83.92%, females accounted for 16.08%; 599 cases were ≥61 years, males accounted for 78.25%, females accounted for 21.75%. Compared with males, the proportion of females ≥61 is higher than that of men. Majority (n = 787; 66.69%) had HBV infection; second commonest cause was HCV infection (n = 217; 18.39%). More patients with HBV infection were 41‐60 years (69.06%) and were younger than HCV patients. There was no statistical difference in etiology, age, gender, and distribution of diabetes mellitus among different Barcelona clinic liver cancer stages (P > .05). The overall Hepatocellular carcinoma (HCC) was found to be positively correlated with alkaline phosphatase, γ‐glutamyltransferase, and alpha‐fetoprotein and liver stiffness measurement values from stage A to stage D (P < .05). ANOVA analysis showed that the overall liver stiffness measurement among the four BCLC stages was found to be statistically significant different in HBV‐infected and HCV‐infected HCC patients. Conclusion Majority (99.24%) were patients aged >40 years old. Male is a high incidence population. In etiological analysis, HBV dominates HCC occurrence, HBV‐, HCV‐, and alcohol‐associated HCC have distinct clinical and biochemical characteristics, necessitating different screening policies to optimize HCC surveillance and management.

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The Barthel Index predicts surgical textbook outcomes following hepatectomy for elderly patients with hepatocellular carcinoma: A multicenter cohort study

Yang,

Liu,

Qiu

et al. 2024

The American Journal of Surgery

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Management and prognosis of hepatocellular carcinoma in the elderly: Results of an in‐field multicenter cohort study

Abstract: Age per se does not impact on short-mid-term prognosis (≤24 months) of HCC patients, and should not represent a limitation to its management.

Cited by 15 publications

References 41 publications

Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults

Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults

Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease

The Barthel Index predicts surgical textbook outcomes following hepatectomy for elderly patients with hepatocellular carcinoma: A multicenter cohort study

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