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World J Gastroenterol. Jul 21, 2019; 25(27): 3563-3571
Published online Jul 21, 2019. doi: 10.3748/wjg.v25.i27.3563
Is the treatment outcome of hepatocellular carcinoma inferior in elderly patients?
Kevin Ka Wan Chu, Kenneth Siu Ho Chok
Kevin Ka Wan Chu, Department of Surgery, Queen Mary Hospital, Hong Kong, China
Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Chok KSH conceptualized and supervised the study; Chu KKW did the literature review and data analysis, wrote the manuscript, prepare the table and generate the schematic diagram; both authors approved the submitted version of manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kenneth Siu Ho Chok, FRCS (Ed), Associate Professor, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. chok6275@hku.hk
Telephone: +852-2255-3025Fax: +852-2816-5284
Received: March 30, 2019
Peer-review started: April 1, 2019
First decision: April 30, 2019
Revised: May 15, 2019
Accepted: June 22, 2019
Article in press: June 30, 2019
Published online: July 21, 2019
Abstract

In view of the increasing life expectancy in different parts of the world, a larger proportion of elderly patients with hepatocellular carcinoma (HCC) requiring oncological treatment is expected. The clinicopathological characteristics of HCC in elderly patients and in younger patients are different. Elderly patients, in general, also have more comorbidities. Evaluation of the efficacy of different HCC treatment options in elderly patients is necessary to optimize treatment outcomes for them. Treatment modalities for HCC include hepatectomy, liver transplantation, radiofrequency ablation, transarterial chemoembolization, and molecular-targeted therapy with sorafenib. In this review, current evidence on the risks and outcomes of the different HCC treatments for elderly patients are discussed. According to data in the literature, elderly patients and younger patients benefited similarly from HCC treatments. More clinical data are needed for the determination of selecting criteria on elderly HCC patients to maximize their chance of getting the most appropriate and effective treatments. As such, further studies evaluating the outcomes of different HCC treatment modalities in elderly patients are warranted.

Keywords: Hepatocellular carcinoma, Aged, Clinical outcome, Surgery, Hepatectomy

Core tip: Elderly patients and younger patients benefited similarly from hepatocellular carcinoma (HCC) treatments. Advanced age and comorbidity are intrinsic factors in elderly HCC patients but should not preclude them from receiving treatments. Patients should be evaluated individually and treatment options should be personalized. All treatment options available to the young should be made available to the elderly. Careful assessment of clinical status, cancer stage and comorbidity is needed to ensure good treatment outcomes.