Outcomes of surgical resection and transarterial chemoembolization in elderly patients with hepatocellular carcinoma: A meta-analysis

Abstract

Significance: There is controversy on management options for early to intermediate hepatocellular carcinoma (HCC) in elderly patients due to concerns about safety and efficacy. This meta-analysis aimed to evaluate the overall survival (OS) and treatment complications of surgical resection (SR) and transarterial chemoembolization (TACE) in elderly compared to non elderly HCC patients

Methodology: A systematic search in MEDLINE, Cochrane Library, Scopus, and Science Direct from inception up to October 2021 was made to identify comparative studies with outcomes of SR and TACE in elderly and non-elderly patients with HCC.

Results: Thirty-nine studies were included. The elderly group had more comorbidities than the non-elderly group. Among those who underwent SR, there were more postoperative complications in the elderly (OR 1.16; 95%CI 1.03, 1.39, p = 0.02). In terms of OS, there were similar outcomes in the first year (OR 0.93; 95%CI 0.71, 1.21, p = 0.59), third year (OR 0.96; 95%CI 0.85, 1.07, p = 0.44), and fifth year (OR 0.82; 95%CI 0.68,1.00, p = 0.05). Among patients who underwent TACE, there was a similar prevalence of post-procedure complications (OR 0.95; 95%CI 0.71, 1.26, p = 0.72). Survival outcomes were also similar between the elderly and non-elderly group in the first year (OR 1.21; 95%CI 0.78, 1.88, p = 0.39), third year (OR 1.21; 95%CI 0.79, 1.85, p = 0.37), and fifth year (OR 0.70; 95%CI 0.40, 1.23, p = 0.22).

Conclusion: Long-term outcomes of SR and TACE are similar between elderly and non-elderly patients with HCC. Hence, age alone should not disqualify HCC patients from receiving curative resection, or even locoregional therapies such as TACE.