1000 Older Adults With Hepatocellular Carcinoma Are More Likely Than Younger Adults to Receive Curative Treatment but Have Worse Overall Survival

Abstract

INTRODUCTION: Hepatocellular carcinoma (HCC) incidence rates are increasing among older adults in the U.S. Age-related disparities in prognosis and treatment receipt have been described in other cancers; however, there are limited data examining outcomes in older adults with HCC. Our study's aim was to evaluate age-related differences in HCC treatment receipt and prognosis. METHODS: We performed a retrospective study of patients diagnosed with HCC between 2008 and 2017 at 2 U.S. hospital systems. Older and younger adults were defined as ≥65 and <65 years old, respectively. Curative therapy was defined as liver transplantation, surgical resection, or local ablation. We used multivariable logistic regression to identify factors associated with curative treatment receipt and Cox proportional hazard models to identify factors associated with overall survival (OS). RESULTS: Of 1110 patients with HCC, 261 (23.5%) were ≥65 and 849 (76.5%) were <65 years old; the cohort was racially/ethnically diverse (33.3% white, 32.4% black, 27.5% Hispanic). A higher proportion of older adults had non-viral cirrhosis compared to younger adults (46.1% vs 21.8%, P < 0.001). A similar proportion of HCC were detected by surveillance in both groups (41.0% vs 40.0%, P = 0.80), but a higher proportion of older adults presented with early stage HCC (BCLC 0/A; 44.8% vs 40.6%, P < 0.001) compared to younger adults; further, a higher proportion of older adults had Child A cirrhosis (61.1% vs 43.4%, P < 0.001) compared to younger adults. Among treated patients (n = 750), older adults were more likely to receive curative therapy (OR 1.71, 95% CI 1.06–2.77) even after adjusting for sex, race, Child Pugh score, BCLC stage and ECOG performance status; there was no significant difference in complete response rates (31.0% vs 28.9%, P = 0.58) between older and younger adults. Among those who received curative therapy, median OS was significantly lower among older compared to younger adults (37.9 vs 57.5 months, P = 0.04) while survival was similar among older and younger adults receiving palliative HCC therapy (12.6 vs 12.2 months, P = 0.46) and best supportive care (1.6 vs 2.4 months, P = 0.05). Older adults had higher mortality than younger adults (HR 1.28, 95%CI 1.05–1.56) after adjusting for sex, race, Child Pugh score, BCLC stage and ECOG performance status. CONCLUSION: Despite being more likely than younger adults to receive curative treatment, older adults with HCC had worse overall survival, independent of BCLC stage or cirrhosis severity.