Data driven decision-making for older patients with hepatocellular carcinoma

Area of Science:

• Hepatology
• Geriatric Oncology
• Surgical Oncology

Background:

• Hepatocellular carcinoma (HCC) risk increases with age.
• Treatment options for older HCC patients are poorly understood, complicating clinical decisions.

Purpose of the Study:

• To review evidence on the safety and efficacy of HCC treatments in older adults.
• To guide optimal treatment decision-making for elderly HCC patients.

Main Methods:

• Systematic review of existing literature on HCC treatment outcomes in older populations.
• Analysis of safety (mortality, morbidity) and efficacy (survival, disease-free survival) data.

Main Results:

• Surgical resection for HCC shows similar safety (90-day mortality ~3%) and efficacy (5-year DFS ~40%) in older vs. younger patients.
• Ablation therapy offers >50% 5-year survival with ~3% morbidity in older HCC patients.
• Chemoembolisation provides ~30% survival, reflecting its palliative role; transplantation has high risks and lower transplant likelihood.

Conclusions:

• Individualized assessment is crucial for older HCC patients, considering risk profiles and survival probabilities.
• Surgical resection is preferred for patients with ≥3 years life expectancy and adequate reserve.
• Loco-regional therapies, guided by tumor size (≤3 cm for ablation), are suitable for patients with <3 years life expectancy.