P-0096 - Management of HCC in elderly patients: an Italian “in field” experience

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Geriatric Oncology
Hepatobiliary Cancers
Presenter Elena Dionigi
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors E. Dionigi1, M. Borzio2, R. Sacco3
  • 1Gastroenterologia Melegnano, Melegnano/IT
  • 2Ospedale di Melegnano, Melegnano/IT
  • 3Ospedale Cisanello Pisa, Pisa/IT

Abstract

Introduction

The number of elderly patients with HCC has been progressively increasing. However, only few studies have been so far carried out to explore whether or not these difficult-to-manage patients may have a different outcome as to their younger counterpart. In particular, data on elderly patients collected in every day clinical practice are still incomplete. In this multicenter “in field” study we compared the presenting features and outcome of HCC in elderly and younger patients.

Methods

From September 2008 to September 2012, 806 consecutive cirrhotic patients with HCC (363 aged < 70: Group (G) 1 and 443 ≥ 70: Group (G) 2) were included. Inclusion criteria were a) newly detected HCC and b) presence of cirrhosis. Patients were classified according to Child-Pugh and Meld score and BCLC staging system. No prefixed protocols regarding diagnosis and management of HCC were operative.

Results

Mean age was 61.1± 7.1 in G1 and 76.1± 4.4 in G2. Male were more prevalent in G1 (84% vs 65%; p < 0.001). Relevant comorbidities were more frequent in G2 than in G1 (33% vs 22%: p < 0.05). As to the etiology, HBV was higher in G1 while HCV was higher in G2 (p < 0.001). G2 patients were more frequently scored as Child A (67% vs 61%: p = 0.02) and BCLC 0/A (23% vs 17%: p = 0.023), MELD score was similar. US regular surveillance was equally distributed in the two groups. Monofocal HCC was more frequently diagnosed in G2 and diffuse HCC was higher in G1 (p < 0.001); mean size of HCCC was similar in G1 and G2. The rate of treated patients was similar in G1 and G2 (77% vs 70%) while ablative therapy was more frequently offered to G2 patients (p < 001). Mean survival of elderly and younger patients was comparable (30.6 ± 1.4 and 29.9 ± 1.2 months) and did not differ in each treatment subgroup.

Conclusion

Results of this “in field” study showed that elderly patients, although often carrying relevant comorbidities, were managed to a similar extent as to their younger counterpart. This is reflected in a comparable mean survival. A higher prevalence of HCV-related HCC in the elderly may explain a better tumour presentation allowing the offer of a curative treatment even in these difficult-to-manage patients. These data are impressive being obtained in every day clinical practice and considering the progressive aging of HCC in the near future.