Carcinoma hepatocelular en el anciano: características clínicas, análisis de supervivencia y factores pronósticos en una cohorte de pacientes españoles mayores de 75 años

Abstract

Hepatocellular carcinoma (HCC) remains poorly characterized in elderly patients with comorbid conditions, a fact that limits the clinical management of the disease. This study analyzes the natural history of HCC in patients older than 75, and determines factors that condition their survival. A retrospective analysis of 235 patients with HCC divided into 2 groups by age at diagnosis: < or = 75 (n = 186) and > 75 (n = 49). After comparing their clinical variables (chi2 and t test), a logistic regression analysis was performed to determine factors associated with receiving locoregional treatment (versus symptomatic treatment). Survival in the 2 groups was compared using a log rank test with subsequent multivariate analysis (Cox proportional hazards model). There were no differences between groups for sex, presence of cirrhosis, etiology, Child-Pugh score, BCLCancer stage, presence of ascites or portal thrombosis, or bilirubin, AST, ALT, gammaGT, LDH or hematocrit values. Patients of advanced age were more frequently diagnosed in the presence of clinical manifestations, and had multifocal, non-localized disease and alpha-fetoprotein levels > 400 ng/mL (all p < 0.05). This group received exclusively symptomatic treatment in 78% of cases (compared to 33% in younger patients), and only 3 of them underwent surgical resection (p < 0.0001). Age older than 75 was a predictive factor for not receiving locoregional therapy (p < 0.0001). Survival in the elderly group (9.8 +/- 1 months) differed substantially from that of younger patients (25.6 +/- 2 months) (p < .00001). Advanced age continued to be a prognostic factor of poor survival in the multivariate analysis (p = 0.025), but lost significance when the analysis was stratified by treatment subgroups (p = 0.344). The lower survival seen in elderly patients with HCC, beyond differences in tumor extension or liver failure, seems conditioned by the use of suboptimal treatment in this population.