Article Sidebar
Main Article Content
Outcome and Prognosis of Invasive Treatment for Hepatocellular Carcinoma in Very Elderly Patients Over 90 Years Old
Main Article Content
Abstract
Background/Aims: To evaluate invasive treatment outcomes for hepatocellular carcinoma (HCC) in patients aged over 90 years.
Materials and methods: Twenty-six patients were included. Information on backgrounds, course of treatment, outcomes, and changesin Child–Pugh (CP) score and performance status (PS), as well as a comparison of treatment-related complications and 2-year survival after treatment, were retrospectively examined and compared with 311 patients aged under 90 years who were matched under the same conditions.
Results: The mean patient age was 91.1 years. Seventeen patients had cirrhosis. The CP score was ≤ 7 across all cases. The Barcelona Clinic Liver Cancer stage was ≤B across all cases. The initial treatments were percutaneous local treatment and transcatheter arte-rial chemoembolization in 14 and 12 cases, respectively. Several patients with postoperative delirium and cognitive impairment were observed. No significant early post-treatment declines were observed in hepatic reserve and PS. The cumulative survival rates after treatment were 77.8% and 61.5% at 12 and 24 months, respectively. The 2-year survival after treatment for patients aged under 90 years was 87.4% and 75.7% at 12 and 24 months, respectively. No significant difference was observed in treatment-related complica-tions or 2-year survival rates between patients aged over and under 90 years.
Conclusion: This is the first report to analyze the course of invasive treatment for HCC in patients aged over 90 years. Safety wasensured if hepatic reserve and PS were maintained. The 2-year survival was comparable with that of patients aged under 90 years, sug-gesting benefit from HCC treatment.
Cite this article as:Yokoyama K, Tokushige H, Nagata T, et al. Outcome and prognosis of invasive treatment for hepatocellular
carcinoma in very elderly patients over 90 years old. Turk J Gastroenterol. 2025;36(6):381-389.
Article Details
References
1. El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365(12):1118-1127. [CrossRef]
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. [CrossRef]
3. Chung H, Ueda T, Kudo M. Changing trends in hepatitis C infection over the past 50 years in Japan. Intervirology. 2010;53(1):39-43. [CrossRef]
4. The European Commission, the Economic Policy Committee (ASSOCIATION FOR WOMEN GEOSCIENTISTS). The 2012 Ageing Report: Economic and Budgetary Projections for the EU27 Member States (2010–2060). Brussels: European Union; 2012.
5. Kudo M. Surveillance, diagnosis, and treatment outcomes of hepatocellular carcinoma in Japan: 2021 update. Liver Cancer. 2021;10(3):167-180. [CrossRef]
6. Mirici-Cappa F, Gramenzi A, Santi V, et al. Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience. Gut. 2010;59(3):387-396. [CrossRef]
7. Zhou L, Rui JA, Wang SB, et al. Clinicopathological features, post-surgical survival and prognostic indicators of elderly patients with hepatocellular carcinoma. Eur J Surg Oncol. 2006;32(7):767-772. [CrossRef]
8. Reddy SK, Barbas AS, Turley RS, et al. Major liver resection in elderly patients: a multi-institutional analysis. J Am Coll Surg. 2011;212(5):787-795. [CrossRef]
9. Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol. 2016;22(1):7-17. [CrossRef]
10. Wang J, Wu R, Sun JY, Lei F, Tan H, Lu X. An overview: management of patients with advanced hepatocellular carcinoma. BioSci Trends. 2022;16(6):405-425. [CrossRef]
11. Karaoğullarından Ü, Üsküdar O, Odabaş E, Ak N, Kuran S. Hepatocellular carcinoma in cirrhotic versus noncirrhotic livers: clinicomorphologic findings and prognostic factors. Turk J Gastroenterol. 2023;34(3):262-269. [CrossRef]
12. Peng P, Wen B, Chen R, Deng X. Sorafenib plus hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma: a systematic review and meta-analysis. Turk J Gastroenterol. 2023;34(4):311-321. [CrossRef]
13. European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908-943. [CrossRef]
14. Kudo M, Izumi N, Kokudo N, et al. Management of hepatocellular carcinoma in Japan: Consensus-Based Clinical Practice Guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis. 2011;29(3):339-364. [CrossRef]
15. Chu KKW, Chok KSH. Is the treatment outcome of hepatocellular carcinoma inferior in elderly patients? World J Gastroenterol. 2019;25(27):3563-3571. [CrossRef]
16. Nishikawa H, Kita R, Kimura T, et al. Transcatheter arterial chemoembolization for intermediate-stage hepatocellular carcinoma: clinical outcome and safety in elderly patients. J Cancer. 2014;5(7):590-597. [CrossRef]
17. Cohen MJ, Bloom AI, Barak O, et al. Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma. World J Gastroenterol. 2013;19(16):2521-2528. [CrossRef]
18. Brunot A, Le Sourd S, Pracht M, Edeline J. Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocell Carcinoma. 2016;3:9-18. [CrossRef]
19. Hiraoka A, Michitaka K, Horiike N, et al. Radiofrequency ablation therapy for hepatocellular carcinoma in elderly patients. J Gastroenterol Hepatol. 2010;25(2):403-407. [CrossRef]
20. Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020-1022. [CrossRef]
21. Guy J, Kelley RK, Roberts J, Kerlan R, Yao F, Terrault N. Multidisciplinary management of hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2012;10(4):354-362. [CrossRef]
22. Takahashi H, Mizuta T, Kawazoe S, et al. Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients. Hepatol Res. 2010;40(10):997-1005. [CrossRef]
23. Kao WY, Chiou YY, Hung HH, et al. Younger hepatocellular carcinoma patients have better prognosis after percutaneous radiofrequency ablation therapy. J Clin Gastroenterol. 2012;46(1):62-70. [CrossRef]
24. Sato M, Tateishi R, Yasunaga H, et al. Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients. J Gastroenterol. 2012;47(10):1125-1133. [CrossRef]
25. Wong H, Tang YF, Yao TJ, et al. The outcomes and safety of single-agent sorafenib in the treatment of elderly patients with advanced hepatocellular carcinoma (HCC). Oncologist. 2011;16(12):1721-1728. [CrossRef]
26. Williet N, Clavel L, Bourmaud A, et al. Tolerance and outcomes of sorafenib in elderly patients treated for advanced hepatocellular carcinoma. Dig Liver Dis. 2017;49(9):1043-1049. [CrossRef]
27. El-Khoueiry AB, Sangro B, Yau T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017;389(10088):2492-2502. [CrossRef]
28. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752-762. [CrossRef]
29. Koya S, Kawaguchi T, Hashida R, et al. Effects of in-hospital exercise on liver function, physical ability, and muscle mass during treatment of hepatoma in patients with chronic liver disease. Hepatol Res. 2017;47(3):E22-E34. [CrossRef]
30. Ramai D, Dang-Ho KP, Kewalramani A, et al. Hospital frailty risk score is independently associated with mortality and encephalopathy in hospitalized patients with hepatocellular carcinoma. Biomedicines. 2021;9(11):1693. [CrossRef]