Achieving Sufficient Therapeutic Outcomes of Surgery in Elderly Hepatocellular Carcinoma Patients through Appropriate Selection

Background and aim The incidence of hepatocellular carcinoma (HCC) is positively correlated with age, and the population of patients with HCC was also older at the time of clinical diagnosis. In the SURF trial, elderly people aged ≥80 years were excluded. We aimed to study the efficacy and safety of radiofrequency ablation (RFA) for patients aged over 80 years. Methods Patients who underwent RFA at our institution for the initial treatment of HCC tumors with largest diameters of ≤3 cm, and ≤3 HCC nodules from January 2011 to December 2023. Treatment outcomes and prognoses were examined in the elderly group (≥80 years) and in the nonelderly group (&lt;80 years). The Cox proportional hazards model was used to determine the factors associated with treatment outcomes and prognoses. Results Of the 518 eligible patients, 136 patients were aged ≥80 years. The median overall survival (OS) values were 80 (95%CI; 60–96) and 123 (95%CI; 101–nucleotide analogs (NA)) months (p = 0.021) in the elderly and nonelderly groups, respectively. For liver disease-related deaths, the median OS values were 97 (95% CI; 80–NA) and NR (95% CI; NA–NA) months (p = 0.62) in the elderly and nonelderly groups, respectively. In the multivariate analysis, factors associated with OS were ALBI grade 2 or 3 (HR, 1.67, 95%CI; 1.07–2.60), DCP ≥ 40 mAU/ml (HR, 2.08, 95%CI; 1.42–3.04), persistent hepatitis C virus (HCV) infection (HR, 5.46, 95%CI; 3.08–9.69), and nonviral liver disease (HR, 4.19, 95%CI; 2.32–7.57). The median recurrence-free survival values were 16 (95%CI; 14–22) and 26 (95%CI; 19–30) months, respectively (p = 0.023). HCC recurrence was significantly associated with the male sex (HR, 1.50, 95%CI; 1.17–1.93), elderly group (HR, 1.37, 95%CI; 1.10–1.95), ALBI grade 2 or 3 (HR, 1.39, 95%CI; 1.07–1.80), DCP ≥ 40 mAU/ml (HR, 1.41, 95%CI; 1.10–1.81), and persistent HCV infection (HR, 1.67, 95%CI; 1.30–2.15). The factors associated with liver disease-related death were ALBI grade 2 or 3 (HR, 2.17, 95% CI; 1.26–3.75), DCP ≥ 40 mAU/ml (HR, 2.33, 95% CI; 1.47–3.69), and persistent HCV infection (HR, 2.22, 95% CI; 1.39–3.56). Conclusions In RFA for tumors with diameters of ≤3 cm and ≤3 HCC nodules, age over ≥80 years was not a significant factor associated with OS or liver disease-related death. The results support that RFA would be a promising treatment option for patients with HCC patients aged ≥80 years. 

Clinical outcome of radiofrequency ablation in patients with hepatocellular carcinoma aged 80 years and older

https://www.ahbps.org/journal/download_pdf.php?doi=10.14701/ahbps.2022S1.OP-2-6

Clinical effectiveness and safety of laparoscopic liver resection versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis

Although the disease burden of elderly cancer patients is rapidly increasing, reliable scientific information, value and preference information of domestic patients, and standardized guidelines for determining the treatment of elderly cancer patients are lacking. The aim of this study is to compare the therapeutic effects of radiofrequency ablation (RFA) and surgery in hepatocellular carcinoma (HCC) patients aged 65 years or older. For the meta-analysis, the databases including PubMed (MEDLINE), EMBASE, OVID Medline, and the Cochrane Library were systematically searched. After the abstract-based review by two investigators, selected manuscripts were read in detail. The surgery group showed higher overall survival (OS) (HR 1.44, 95% CI 1.22-1.70) and disease-free survival (DFS) (HR 1.40, 95% CI 1.00-1.97) than the RFA group. This was also shown in small HCC of less than 3 cm (OS, HR 1.42, 95% CI 1.00-2.03; DFS, HR 1.32, 95% CI 0.91-1.91). This might be related to the high local recurrence in the RFA group (OR 4.90, 95% 2.16-11.08). On the other hand, adverse events were significantly lower in the RFA group (OR 0.22, 95% CI 0.14-0.36), which led to a decrease in the duration of hospital stay (mean difference -14.88 days, 95% CI -22.44--7.32). In elderly HCC patients, survival in the surgery group was significantly higher than in the RFA group, but various complications tended to increase; so, appropriate patient selection is required.

Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Many countries have published clinical practice guidelines for appropriate clinical decisions, optimal treatment, and improved clinical outcomes in patients with acute coronary syndrome. Developing guidelines that are specifically tailored to the Korean environment is crucial, considering the treatment system, available medications and medical devices, racial differences, and level of language communication. In 2017, the Korean Society of Myocardial Infarction established a guideline development committee. However, at that time, it was not feasible to develop guidelines, owing to the lack of knowledge and experience in guideline development and the absence of methodology experts. In 2022, the National Evidence-Based Healthcare Collaborating Agency collaborated with a relevant academic association to develop internationally reliable guidelines, with strict adherence to the methodology for evidence-based guideline development. The first Korean acute coronary syndrome guideline starts from the 9 key questions for pharmacotherapy.

2024 Korean Society of Myocardial Infarction/National Evidence-Based Healthcare Collaborating Agency Guideline for the Pharmacotherapy of Acute Coronary Syndromes

Background/Aims
: With increased life expectancy, the management of elderly hepatocellular carcinoma (HCC) patients became a crucial issue, yet it is still challenging due to comorbidities and high surgical risks. While surgical resection is considered as primary treatment for eligible HCC patients, systematic evidence on its outcomes in elderly patients remains scarce. In this review, we aimed to analyze the efficacy and safety outcomes of surgical resection in elderly HCC patients.


Methods
: The studies included in this meta-analysis were selected from Ovid-MEDLINE, Ovid-Embase, CENTRAL, KoreaMed, KMbase, and KISS databases following a predefined protocol. Efficacy outcomes included overall survival and disease-free survival, while the safety outcomes included postoperative mortality and complications.


Results
: Patients in the elderly group (≥65 years) who underwent surgery exhibited non-inferior overall survival (hazard ratio [HR], 1.26; 95% confidence interval [CI], 0.92 to 1.74) and disease-free survival (HR, 1.03; 95% CI, 0.99 to 1.08) compared to the non-elderly group. Overall postoperative mortality exhibited no statistical difference (odds ratio [OR], 1.07; 95% CI, 0.87 to 1.31), but 30-day, 90-day, and in-hospital mortality were higher in the elderly group. The incidence of overall complications was higher in the elderly group (OR, 1.44; 95% CI, 1.22 to 1.69). Sensitivity analysis for the super elderly group (≥80 years) showed significantly higher in-hospital mortality compared to the non-super elderly group (OR, 2.51; 95% CI, 1.16 to 5.45).


Conclusions
: The efficacy outcome of surgical resection in the elderly HCC patients was not worse than that in the non-elderly HCC patients, while in-hospital mortality and complications rates were higher. Therefore, surgical resection should be purposefully considered in the elderly population, with careful candidate selection.

Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Navigating the Gray Zone: Physicians’ Perspectives on Treatment Decision-Making in Elderly Cancer Patients in Korea

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