Hepatocellular Carcinoma in Older Adults: Clinical Features, Treatments, and Survival

Objectives: To evaluate the clinical features, treatments, stages, and survival in older adults with hepatocellular carcinoma (HCC).

Design: A consecutive case study with retrospective medical record review.

Setting: University hospital (tertiary referral center) in Korea.

Participants: Two hundred sixty-two participants with HCC diagnosed between May 1, 2003, and December 31, 2006.

Measurements: Clinical characteristics, treatments, four staging systems for HCC, and survival in older (≥65, n=113) and younger (<65, n=149) people with HCC.

Results: The older HCC group were less likely to have hepatitis B virus infection and diffuse tumors and had more comorbidities, poorer performance status, smaller tumor area, and multinodular disease. There were no significant differences between the two groups with regard to Child-Pugh-Turcotte score, Model for End Stage Liver Disease (MELD) score, Child class, alpha-fetoprotein levels, and tumor stage at diagnosis. Approximately 88% of subjects were treated regardless of age, but resection was performed less frequently in the older participants. Older participants with HCC had overall survival and liver-related mortality similar to those of the younger participants, although they had poorer performance, greater comorbidity, and less likelihood of receiving surgery than the younger patients.

Conclusion: This study supports the effectiveness and safety of nonsurgical treatment for older adults with HCC. Further study is needed to elucidate the reasons for similar prognoses in the older adults in spite of the greater burdens of comorbidities and poorer performance status.