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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 18, 2015; 7(11): 1521-1529
Published online Jun 18, 2015. doi: 10.4254/wjh.v7.i11.1521
Management of hepatocellular carcinoma in the elderly
Mauro Borzio, Elena Dionigi, Giancarlo Parisi, Ivana Raguzzi, Rodolfo Sacco
Mauro Borzio, Elena Dionigi, Ivana Raguzzi, Unità di Gastroenterologia, Azienda Ospedaliera di Melegnano, 20070 Vizzolo Predabissi, Italy
Giancarlo Parisi, Dipartimento di Medicina, Ospedale Santa Maria del Prato, 32032 Feltre, Italy
Rodolfo Sacco, Unità di Gastroenterologia, Ospedale Cisanello, 56124 Pisa, Italy
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: None to declare.
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/
Correspondence to: Dr. Mauro Borzio, Unità di Gastroenterologia, Azienda Ospedaliera di Melegnano, Via Pandina 1, 20070 Vizzolo Predabissi, Italy. mauro.borzio@gmail.com
Telephone: +39-02-92360317 Fax: +39-02-92360829
Received: December 22, 2014
Peer-review started: December 24, 2014
First decision: February 7, 2015
Revised: March 9, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: June 18, 2015
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.