Hepatocellular carcinoma in the elderly: Results of surgical and nonsurgical management

OBJECTIVE: This study evaluated the results of surgical and nonsurgical tre atments of hepatocellular carcinoma (HCC) in the elderly to determine the o ptimal management strategy. METHODS: Clinicopathological data and treatment results of 222 elderly (gre ater than or equal to 70 yr) and 1116 younger patients with HCC managed bet ween 1989 and 1997 were prospectively collected and compared between the tw o groups. RESULTS: The resection rate in the elderly (14%) was lower than in younger patients (27%) (p < 0.001). Among patients who underwent resection, there w ere no significant differences in morbidity rate (48% vs 40%, p = 0.354), h ospital mortality rate (10% vs 6%, p = 0.431), or long-term survival (media n, 38 vs 42 months, p = 0.940). Comparing the periods 1989-1992 and 1993-19 97, hospital mortality rate in the elderly was reduced from 25% to 4% (p = 0.079). Sixty-seven elderly and 317 younger patients underwent transarteria l oily chemoembolization (TOCE), with similar morbidity rate (24% vs 26%, p = 0.775), mortality rate (7% vs 5%, p = 0.365), and long-term survival (me dian, 12 vs 9 months, p = 0.277). The results of other nonsurgical treatmen ts were also similar between the two groups. CONCLUSIONS: Hepatic resection for HCC is safe in selected elderly patients , and the improved results in recent years indicate that more elderly patie nts could benefit from surgical management. TOCE is well tolerated in elder ly patients and is the treatment of choice for unresectable HCC. The overal l management strategy of HCC in the elderly should not be different from th at in younger patients. (Am J Gastroenterol 1999;94:2460-2466. (C) 1999 by Am. Cell. of Gastroenterology).