Hepatocellular carcinoma in elderly patients: beneficial therapeutic efficacy using percutaneous ethanol injection therapy

Background: The age of patients with hepatocellular carcinoma (HCC) has been increasing worldwide. The objective of this study was to assess the efficacy and safety of percutaneous ethanol injection therapy (PEIT) in elderly patients with HCC.

Methods: The authors retrospectively analyzed 653 patients who were treated with PEIT between 1985 and 1997. One hundred thirty-seven patients were age > or = 70 years, 90 of 137 patients (66%) were male, and 106 of 137 patients (77%) were positive for hepatitis C virus antibodies. Both survival rates and standardized mortality ratios (SMRs) related to the causes of death were compared between patients age > or = 70 years and patients age < 70 years.

Results: With the exception of greater maximum tumor size in elderly patients age > or = 70 years, the clinical features of tumors and underlying liver disease were similar to those of patients age < 70 years The survival rates after PEIT in patients age > or = 70 years were 83%, 52%, and 27% at 1 year, 3 years, and 5 years, respectively. These results were comparable to the rates for patients age < 70 years (1 year, 90%; 3 years, 65%; and 5 years, 40%). In addition, there was no difference in mortality from extrahepatic disease between the two groups (9.8% for patients age > or = 70 years vs. 9.4% for patients age < 70 years; P > 0.999). The SMR of patients age > or = 70 years who died of causes related to extrahepatic disease (SMR, 0.56; 95% confidence interval [95%CI], 0.18-1.30) was lower compared with the SMR of patients age < 70 years (SMR, 1.75; 95%CI, 1.07-2.71). The SMR of patients age > or = 70 years who died of causes related to liver disease (SMR, 115; 95%CI, 84.1-153.0) was similar to that of patients age < 70 years (SMR, 120; 95%CI, 103.0-138.0).

Conclusions: These results provide support for the treatment of patients with HCC age > or = 70 years by tumor ablation using PEIT.