Microwave ablation of hepatocellular carcinomas in octogenarians

Abstract

Aim: To evaluate wether it is safe and meaningful to treat octogenarians with microwave ablation for hepatocellular carcinoma. With an ageing population being healthier than previous generations, old limits for treating disease founded on patient age need to be revised. One of the most common tumour related death causes is hepatocellular carcinoma (HCC). With the development of minimally invasive therapies with curative potential, new ground is being broken offering treatments to older patients in the hope of achieving prolongation and better quality of life. Methods: In this retrospective single centre study of patients having a first microwave ablation therapy for HCC in a national referral centre for ablative liver treatments, septuagenarians (n = 161, age 70-80) were compared with octogenarians (n = 32, age 80-90). Results: Octogenarians selected for microwave ablation of HCC at a regional multidisciplinary team conference have similar outcomes as their younger control group. Survival, complications and length of stay are not different. Conclusion: Octogenarians who are fit for ablative treatment of HCC should not be disqualified on grounds of age, recognising that this group has an obvious immortality, or lead-time, bias as well as a probable selection bias in part explaining their good results.

Safety and Feasibility of Microwave Ablation for Hepatocellular Carcinomas in the Elderly: A Systematic Review

“…Freedman et al. ( 29 ) in their retrospective study comparing first MWA therapy for HCC in septuagenarians ( n = 161) versus octogenarians ( n = 32) showed no difference in OS between the two groups, with a median survival time of 3.9 years for patients between 70 and 80 years of age and 4.3 years for octogenarians ( p = 0.416). The older group had an average age of 82 and a median survival of 4.3 years, whereas the younger cohort had an average age of 74 and a median survival of 3.9 years.…”

“…Seven observational studies ( 9 , 29 – 34 ) involving 7,683 HCC patients were included in our systematic review. All included studies were retrospective cohort studies and the published year ranged between 2018 and 2020 with sample sizes of HCC patients ranging from 30 to 2,389.…”

“…Three studies reported Milan criteria ( 9 , 30 , 32 ), one study used LICRADS ( 29 ), one used pathological examination of a tumor biopsy ( 31 ), and two studies used Chinese guidelines for the clinical diagnosis and staging of primary liver cancer ( 33 , 34 ) as the diagnostic criteria for defining HCC. Only two studies ( 29 , 33 ) reported MELD Score data and four studies ( 29 , 32 – 34 ) reported Child–Pugh score data. However, data to determine outcomes of different treatments (MWA/RFA and TACE) for early-stage HCC in elderly patients were only reported by a single study ( 9 ).…”

“…To our knowledge, this is the first systematic review to qualitatively show that elderly patients, despite having a high comorbidity index, benefited from MWA of HCC in a similar manner to younger patients. It should be noted that all included clinical studies are retrospective ( 9 , 29 – 34 ). This increases the risk of clinical consequences being under-reported or misreported.…”

“…Because of these benefits, MWA has become a popular therapeutic option for hepatic malignancies. Recently, emerging studies have evaluated the efficacy of MWA of HCC in the elderly with conflicting findings ( 9 , 29 – 34 ). Therefore, we conducted this systematic review to assess the safety and feasibility of MWA for HCC in elderly patients.…”