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2014 ; 93
(28
): e264
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Uncompromised treatment efficacy in elderly patients with hepatocellular
carcinoma: a propensity score analysis
#MMPMID25526453
Liu PH
; Hsu CY
; Lee YH
; Hsia CY
; Huang YH
; Su CW
; Chiou YY
; Lin HC
; Huo TI
Medicine (Baltimore)
2014[Dec]; 93
(28
): e264
PMID25526453
show ga
The number of elderly hepatocellular carcinoma (HCC) patients is expected to
rise. We analyzed the impact of age on clinical presentations, treatment
allocation, and long-term survival between elderly (?75 years) and younger (<75
years) HCC patients. In this study, a total of 812 elderly and 2270 younger HCC
patients were evaluated. The baseline information and long-term survival were
compared in the entire population and in different treatment groups. A propensity
score matching analysis with preset caliper width was utilized to compare
survival differences in different patient subgroups. Elderly HCC patients had
discrete characteristics compared with younger HCC patients. Elderly patients
received surgical resection (SR) less frequently, while more elderly patients
underwent radiofrequency ablation (RFA) and transarterial chemoembolization
(TACE). Younger patients had significantly better long-term survival than the
elderly patients in all patients and in patients receiving SR (both P<0.05).
However, of the entire cohort, age was not an independent predictor of poor
prognosis in the Cox multivariate model. The long-term survival was similar
between 2 age groups in patients receiving RFA and TACE. In the propensity model,
there were no significant survival differences among patients receiving SR, RFA,
or TACE (all P>0.05). Among the elderly, the Cancer of the Liver Italian Program
(CLIP) score provided the lowest Akaike information criterion value. In
conclusion, advanced age is not associated with inferior treatment result in HCC
patients receiving different therapeutic modalities. Elderly HCC patients should
be encouraged for active treatment when indicated. The CLIP is an optimal
prognostic model for outcome assessment.