Age does not affect treatments, outcomes in hepatocellular carcinoma
Age appears to not significantly impact treatments and outcomes for hepatocellular carcinoma (HCC), a new study reveals. Survival is comparable between older and younger patients, and equally active treatments should be administered to both age groups.
The study included 1,530 adult patients diagnosed with HCC, of which 20.8 percent (n=318) were older than 65 years while the remaining 79.2 percent (n=1,212) were younger. Cigarette and alcohol use and liver cirrhosis were significantly more common in younger patients (p<0.05 for all).
Prior to propensity score matching, there was no significant difference in 30-day mortality between the two groups (p=0.884). In contrast, the 90-day mortality was significantly higher in older than in younger patients (13.2 vs 9.4 percent; p=0.048). The global median 1-, 3- and 5-year survival rates were also worse in older patients.
After propensity score matching for preoperative status, liver function, tumour size and vascular invasion, among others, the statistically significant difference in 90-day mortality was attenuated.
In spite of this, older patients were given curative treatments, such as surgical resection (28.9 vs 24.6 percent) and liver transplant (3.3 vs 0 percent), significantly less than younger patients (p<0.001).
“These findings implied that even with similar host factors and tumour burden, older patients tended to be less aggressively treated than younger patients, which might account for the diminished long-term outcome of elderly patients,” said researchers.
Subsequent multivariable analysis showed that age (hazard ratio [HR], 1.1; 95 percent CI, 0.9 to 1.3; p=0.281) did not significantly affect survival. On the other hand, curative treatments (HR, 0.5; 0.4 to 0.6; p<0.001), locoregional therapies (HR, 0.8; 0.7 to 0.9; p<0.001) and the Eastern Cooperative Oncology Group scores (HR, 1.4; 1.2 to 1.6; p<0.001) were all significantly associated with survival.