The influence of age in decision-making of patients with HCC

Abstract

BackgroundHepatocellular carcinoma (HCC) is usually associated withliver cirrhosis and is the principal cause of death amongpatients with cirrhosis [1]. Apart from liver transplantationthat may cure both conditions, treatment of HCC and cir-rhosis is complex because of the need to be oncologicallyradical but simultaneously conservative. Hepatectomy isconsidered an invasive approach and has a marginal rolein the treatment of HCC [2,3]. A retrospective analysis of62 patients affected by HCC observed from 2000 to 2008was performed. The treatment choice was compared withthe treatment schedule proposed by BCLC. Among thesepatients, 27 (43.5%) were over 70 years old; of these 16were men and 11 women. Regarding Child classification18 patients (66.6%) were CHILD A, 8 (29.6 %) CHILD Band 1 (3.8%) CHILD C. We evaluated the influence of agein our clinical behaviour, exploiting the BCLC guidelines.In 9 (33.3 %) cases patients were treated according toBCLC algorithm but mainly with percutaneous ablationtherapies, while in the remaining18 (66.7%) cases therewas an undertreatment in 15 (83.3 %) patients and anovertreatment in 3 (16.7 %). About the undertreatmentcases we didn’t perform hepatic resection or liver trans-plantation such as BCLC suggests mainly because ofadvanced age (> 70 years old). With regard to the over-treatment we performed 3 transarterial embolizationsrather than sorafenib or symptomatic therapy because thegeneral conditions of patients were fairly good.ConclusionsBCLC algorithm is considered the most important sta-ging system for patients with HCC. This classificationuses variables related to tumour stage, liver functionalstatus, physical status but not the age of patients. Thisconcept is very important because decision-making ofhepatic surgeons often depends on age of patient.Although there are many papers in scientific literaturethat confirm the safety of surgery in elderly patients, itis also true that the risk of local and general complica-tionsisveryhigh.Thepresenceofcomorbidityandrefusal of patients to undergo surgery or liver transplan-tation are often the main reason for our clinical beha-viour. In the management of these patients we have toconsider the age and risk-benefit ratio.