Dohmen K et al. (2004) Optimal treatment strategy for elderly patients with hepatocellular carcinoma. J Gastroenterol Hepatol 19: 859–865

The incidence of hepatocellular carcinoma (HCC) is on the rise in a number of countries, partly because of an increase in the rate of hepatitis infection. As the population ages, the proportion of elderly HCC patients is likely to grow. Dohmen and colleagues have carried out a retrospective study to compare the clinical and prognostic characteristics of elderly HCC patients with those of their younger counterparts.

HCC patients consecutively diagnosed during a 12-year period were divided into two groups: the ‘elderly’ group (n = 36) aged 80 years or older and the ‘non-elderly’ group (n = 668). Clinical variables (sex, hepatitis C and hepatitis B markers, concentration of serum alpha-fetoprotein, diameter and number of tumors, Child’s grade, presence of portal thrombosis, histological grade, types of treatment and survival) were compared between the two groups and prognostic factors were identified.

All clinical features—including survival rate—were similar between the two groups. The elderly group revealed presence of portal thrombosis as the only significant prognostic factor, whereas prognosis in the non-elderly group was influenced by nonsolitary tumors, Child’s grade of B or C, tumor diameter of >3 cm and presence of portal thrombosis.

Since age did not appear to influence survival rate in this study, the authors propose that patients with HCC should be selected for aggressive treatment strategies based on their risk factors, irrespective of age.