Management of hepatocellular carcinoma in the elderly

Abstract

Mean age of hepatocellular carcinoma (HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under- or no-treatment of aged patients should not be longer justified.

Keywords: Hepatocarcinoma; Epidemiology; Cirrhosis; Elderly; Treatment

Core tip: The number of elderly patients with cancer is expected to rise in the next future, and facing with elderly cirrhotic patients with hepatocellular carcinoma (HCC) will characterize liver oncology scenario in the near future. International guidelines do not specifically address how to approach HCC in aged patients and no recommendations are available on age threshold to which clinical decisions should refer. Available data seem to rule out an intrinsic negative impact of age itself on HCC prognosis, and treatment allocation should be decided mainly according to HCC stage, liver residual function and general conditions. Indeed, a nihilistic attitude to restrict treatment in this population is not longer justified.