Treatment options for elderly patients with HCC: liver transplantation, hepatectomy or local treatment?

On May 5-8, 2021 local time, the International Liver Transplant Society (ILTS) annual meeting was successfully held online.

This article will report on a cohort study by scholars from New York, USA.

Liver transplantation: still the best treatment option for elderly patients with transplantable HCC 1.
Research introduction Liver transplantation (LT) can be used to treat hepatocellular carcinoma (HCC) to some extent, but this therapy will increase the risk, and the transplanted organs are currently scarce.
.

In some cases, alternative methods such as local therapy (LRT) or liver resection (LR) also have considerable benefits.

Due to the shortened life expectancy of elderly patients, comprehensive treatment may be the best treatment option.

This study aims to compare the overall survival (OS) differences of elderly HCC patients receiving LT, LR or LRT and find the best treatment options for patients.

This is a retrospective cohort study that continuously enrolled HCC patients who were >65 years old and received LT, LR or LRT interventions between 1998 and 2018.

The patients were divided into 3 groups according to the different interventions received.

The OS from the diagnosis of the 3 groups of patients was compared, and the subgroup analysis was performed on the patients within the Milan criteria.

2.
The results of the study included 466 patients who were >65 years old at the time of diagnosis of HCC, of ​​which 105 received LT, 84 received LR, and 277 received LRT.

In the entire cohort, patients in the LT group were younger than the LR and LRT groups, most often within the Milan criteria, and had a higher score in the model of end-stage liver disease combined with sodium (MELD-Na).

The 5-year OS in the LT group was the highest, followed by LR, and finally LRT (70%, 53%, and 31%, p<0.
001, Figure 1).

Figure 1 Comparison of the 5-year OS of the 3 groups of patients in the entire cohort.
For patients within the Milan criteria, the LT group was also younger and had a higher MELD-Na score.

The 5-year OS of the LT group and the LR group was higher than that of the LRT group (69%, 68%, and 39%, p<0.
001, Figure 2).

Figure 2 compares the 5-year OS3 of 3 groups of patients within the Milan standard.
Research conclusions Overall, LT is still the best treatment option for elderly transplantable HCC patients.

For patients who meet the Milan criteria, the 5-year OS of LR is equivalent to that of LT.

The OS of LRT is relatively low, but it is still a viable alternative treatment for non-transplant patients.

Source: Najjar M, Zou J, Sun S, et al.
Multimodal strategy for hepatocellular carcinoma in the elderly: to transplant or not to transplant.
ILTS 2021.
Abrasts O-069.