Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience
- Federica Mirici-Cappa1,
- Annagiulia Gramenzi1,
- Valentina Santi1,
- Andrea Zambruni1,
- Antonio Di Micoli1,
- Marta Frigerio1,
- Francesca Maraldi1,
- Maria Anna Di Nolfo2,
- Paolo Del Poggio3,
- Luisa Benvegnù4,
- Gianludovico Rapaccini5,
- Fabio Farinati6,
- Marco Zoli7,
- Franco Borzio8,
- Edoardo Giovanni Giannini9,
- Eugenio Caturelli10,
- Mauro Bernardi1,
- Franco Trevisani1,
- for the Italian Liver Cancer (ITA.LI.CA.) group
- 1Dipartimento di Medicina Clinica, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
- 2Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy
- 3Divisione di Medicina, Ospedale Treviglio–Caravaggio, Treviglio, Italy
- 4Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy
- 5Cattedra di Medicina Interna II, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
- 6Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy
- 7Dipartimento di Medicina Interna, dell'Invecchiamento e Scienze Nefrologiche, Alma Mater Studiorum—Università di Bologna, Bologna, Italy
- 8Dipartimento di Medicina, Unità di Gastroenterologia, Ospedale Fatebenefratelli, Milan, Italy
- 9Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy
- 10Unità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy
- Correspondence to Professor Franco Trevisani, Dipartimento di Medicina Clinica, Alma Mater Studiorum—Università di Bologna, Semeiotica Medica, via Albertoni 15, Bologna 40138, Italy;
- Revised 27 November 2009
- Accepted 29 November 2009
Objectives The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is expected to increase. We compared the presenting features and outcome of HCC in elderly (≥70 years) and younger patients (<70 years).
Design Multicentre retrospective cohort study and nested case–control study.
Patients 614 elderly and 1104 younger patients from the ITA.LI.CA database, including 1834 HCC cases consecutively diagnosed from January 1987 to December 2004. Both groups were stratified according to treatment: hepatic resection, percutaneous procedures, transarterial chemoembolisation (TACE). Survival was assessed in the whole population and in each treatment subgroup. Age, sex, aetiology, cirrhosis, comorbidities and cancer stage (CLIP score) were tested as predictors of survival. In each subgroup, differences in patient survival were also assessed after adjustment and matching by propensity score.
Results Ageing was associated with a higher prevalence of comorbidities, better liver function and CLIP score. Regardless of age, two-thirds of patients underwent radical treatments or TACE. Elderly patients underwent more ablative procedures and fewer resections or TACE sessions. The survival of elderly and younger patients was comparable in each treatment subset, and was predicted by CLIP score. This result was confirmed by the propensity analysis.
Conclusions The overall applicability of radical or effective HCC treatments was unaffected by old age. However, treatment distribution differed, elderly individuals being more frequently treated with percutaneous procedures and less frequently with resection or TACE. Survival was unaffected by age and primarily predicted by cancer stage, assessed by the CLIP system, both in the overall population and in treatment subgroups.
- computer tomography
- hepatitis B virus
- hepatocellular carcinoma
- hepatitis C virus
- magnetic resonance
- non-alcoholic steatohepatitis
- percutaneous ethanol injection
- radio-frequency ablation
- transarterial chemoembolisation
Funding This study was partially funded by a grant (Ricerca Fondamentale Orientata 2006-2007) from the Ministero della Istruzione, della Università e della Ricerca (MIUR).
Competing interests None.
Ethics approval This study was conducted with the approval of the Ethics Committee of Policlinico S. Orsola-Malpighi, Bologna.
Provenance and peer review Not commissioned; externally peer reviewed.