Current Status of Therapeutic Choice and Feasibility for Patients with Hepatocellular Carcinoma Aged >= 70 Years: A Nationwide Cancer Registry Analysis

Abstract

Background: The opportunities for examining elderly patients with hepatocellular carcinoma (HCC) have increased. We investigated the treatment of HCC for elderly patients and the overall survival associated with each treatment modality. Methods: From January 2003 to December 2005 (n=578, period I) and January 2008 to December 2014 (n=2428, period II), the National Cancer Center and Korean Liver Cancer Association collected clinical data of 3006 patients with HCC aged >= 70 years old at 54 medical centers in Korea. We analyzed the treatment modalities and overall survival for patients with HCC aged >= 70 years. Results: The mean age, Child-Pugh score, and model for end-stage liver disease score and proportion of male patients were not different between period I and period II (74 years, 6.6, 10.4 and 70.1% vs 76 years, 6.2, 9.9 and 67.3%). TNM stage II and BCLC stage A were most commonly noted in periods I and II (44.3% and 49.1% vs 40.4% and 40.2%). Transarterial therapy was the most commonly used treatment modality according to age in both periods. Surgical resection was associated with significant superior overall survival compared to local ablation and transarterial therapy (p<0.001). After propensity score matching between surgical resection and transarterial therapy in period II, surgical resection was associated with more favorable overall survival outcomes (median: 39 months vs 86 months, p<0.001). Conclusion: Transarterial therapy was the most commonly used treatment modality for patients with HCC aged >= 70 years. However, surgical resection led to significantly higher overall survival rates compared to other treatment modalities.