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Original Article
- The efficacy of treatment for hepatocellular carcinoma in elderly patients
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Han Ah Lee, Sangheun Lee, Hae Lim Lee, Jeong Eun Song, Dong Hyeon Lee, Sojung Han, Ju Hyun Shim, Bo Hyun Kim, Jong Young Choi, Hyunchul Rhim, Do Young Kim
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J Liver Cancer. 2023;23(2):362-376. Published online September 14, 2023
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DOI: https://doi.org/10.17998/jlc.2023.08.03
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Abstract
PDFSupplementary Material
- Background/Aim
Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Methods
Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Results
Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Conclusions
Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.
Review Article
- Practice Guidelines for Management of Hepatocellular Carcinoma: Global Discrepancies and Solution of Local Ablation
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Hong Soo Kim
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Journal of the Korean Liver Cancer Study Group. 2011;11(1):6-11. Published online February 28, 2011
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Abstract
PDF
- A curative modality for hepatocellular carcinoma was a resection or a liver transplantation in a past decades, but nowadays
local ablation therapy like a percutaneous alcohol injection or a radiofrequency ablation is comparable with a surgical
resection. So a local ablation therapy is considered as a curative modality. Recently early detection of a small hepatocellular
carcinoma is becoming easy due to use a suveillance ultrasonography and computed tomography in a high risk patients.
Grobally, an indication for local ablation therapy is a small hepatocellular carcinoma less than 3 cm in diameter and have a
well-reserved liver function. But patients who met above indication is also controlled by a liver transplantation or a surgical
resection. So we should pay attention to a difference between treatment guidelines and a strengths and weaknesses of local
ablation therapy.