Hepatic resection of solitary HCC in the elderly: A unique disease in a growing population

• Published in: The American journal of surgery 2019-05, Vol.217 (5), p.899-905
• Main Authors: Zarour, Luai R., Billingsley, Kevin G., Walker, Brett S., Enestvedt, C. Kristian, Orloff, Susan L., Maynard, Erin, Mayo, Skye C.
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; alpha-Fetoproteins - analysis; Anemia; Biomarkers, Tumor - blood; Cancer therapies; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Classification; Comorbidity; Complications; Data processing; Disease control; Female; Geriatrics; Hepatectomy; Hepatitis; Hepatocellular carcinoma; Hospitals; Humans; Identification methods; Laboratories; Liver cancer; Liver diseases; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Lymphocyte Count; Male; Metabolism; Monocytes - metabolism; Morbidity; Mortality; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neutrophils - metabolism; Older people; Oncology; Pathology; Patients; Platelet Count; Predictive control; Retrospective Studies; Survival
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.01.030

Management of elderly patients with solitary hepatocellular carcinoma (sHCC) is challenging with perceived clinicopathologic differences driving treatment options. We sought to determine factors predictive of disease control and survival after hepatic resection of sHCC in elderly patients. We identified n = 45 elderly patients (³≥65 yo) with sHCC treated with hepatic resection alone from our prospective database from 2003–16. Clinicopathologic data were analyzed and survival was assessed from the time of hepatic resection. The median age was 75-years-old. Less than half of patients (47%) had viral hepatitis. At resection, the median Child-Pugh score was A6, median tumor size 5 cm, and mean AFP of 1050 (ng/mL). Major hepatectomy was performed in 23 patients (51%) with R0 resection achieved in 96%. Two patients (4%) had Grade III complications with no mortalities at 30 days and one death (2%) at 90-days. After R0 resection 44% (n = 20) had intrahepatic recurrence at a median of 32 months (95% CI: 15–46) with 20% (n = 9) developing extrahepatic recurrence at a median of 78 months (95% CI: 78-.). The median survival was 72 months (95% CI: 30–108 months). For patients with at least 3 years of follow-up, the 1-, 3-, and 5-year overall survival was 74%, 59%, and 50%, respectively. Mortality was associated with higher AFP and lower Prognostic Nutritional Index (PNI). Carefully selected elderly patients with sHCC appear to have unique disease that is amenable to hepatic resection with low morbidity and mortality with excellent overall and recurrence-free survival. •Elderly patients with solitary HCC appear to have unique disease that is amenable to hepatic resection.•Patients with resected sHCC have good disease control with a median survival of 72 months— remarkable with the median age 75 years in this cohort.•More than 50% of our elderly patients required a major hepatectomy with 50% having no recurrence after R0 resection.•We demonstrate that preoperative comorbidities did not appear to have a poor prognostic indication on the patients.