Mauro Borzio1, Elena Dionigi1, Alessandro Vitale2, Angelo Rossini3, Massimo Marignani4, Fabio Fornari5, Susanna Vicari6, Ilario De Sio7, Fabio Farinati2, Emanuela Bertolini8, Filippo Oliveri9, Gioacchino Leandro10, Giampiero Francica11, Mario Mitra12, Barbara Omazzi13, Sergio Boccia14, Andrea Salmi15, Anna Toldi16, Rodolfo Sacco17. 1. UOC Gastroenterologia ed Endoscopia Digestiva, ASST Melegnano e della Martesana, Cernusco sul Naviglio, Italy. 2. Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche Azienda Università di Padova, Padova, Italy. 3. Dipartimento di Medicina, SSVD di Epatologia, ASST Spedali Civili di Brescia, Cernusco sul Naviglio, Italy. 4. UOS Malattie delle vie Biliari e del Fegato, UOC malattie dell'Apparato Digerente e del Fegato, AO S.Andrea, Università "Sapienza" Roma, Rome, Italy. 5. Unità di Gastroenterologia ed Epatologia, Ospedale G da Saliceto, Piacenza, Italy. 6. UOS Gastroenterologia Ospedale di Bentivoglio, Bologna, Italy. 7. Unità di Gastroenterologia, Ospedale Policlinico, Napoli, Italy. 8. U.O. Medicina VI Epatologia e Gastroenterologia, Ospedale San Paolo, Università degli Studi di Milano, Milano, Italy. 9. U.O. Epatologia, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy. 10. UO Gastroenterologia, IRCSS de Bellis, Castellana Grotte, Italy. 11. Unità di Ecointerventistica, Presidio Ospedaliero Pineta Grande, Castelvolturno, Italy. 12. UO Medicina Interna I, Ospedale "Civico e Benfratelli", Palermo, Italy. 13. UOC Gastroenterologia, Ospedale G Salvini, Rho, Milano, Italy. 14. UOC Gastroenterologia, Ospedale S.Anna, Ferrara, Italy. 15. Dipartimento Medicina, Università di Verona, Verona, Italy. 16. UO Gastroenterologia Ospedale Valduce, Como, Italy. 17. UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy.
Abstract
AIMS: This multicentre cohort study evaluated the role of ageing on clinical characteristics, treatment allocation and outcome of new hepatocellular carcinomas (HCCs), in clinical practice. MATERIAL & METHODS: From September 2008, 541 patients >70 years old (elderly group), and 527 ≤70 years old (non-elderly group) with newly diagnosed HCC were consecutively enrolled in 30 Italian centres. Differences in clinical characteristics and treatment allocation between groups were described by a multivariable logistic regression model measuring the inverse probability weight to meet the elderly group. Survival differences were measured by unadjusted and adjusted (by inverse probability weight) survival analysis. RESULTS: Elderly patients were mainly females, hepatitis C virus infected and with better conserved liver function (P<.001). At presentation, HCC median size was similar in both groups while, in youngers, HCC was more frequently multinodular (P=.001), and associated with neoplastic thrombosis (P=.009). Adjusted survival analysis showed that age did not predict short-mid-term survival (within 24 months), while it was a significant independent predictor of long-term survival. Moreover, age had a significant long-term survival impact mainly on early HCC stages (Barcelona Clinic for Liver Cancer [BCLC] 0-A), its impact on BCLC B stage was lower, while it was negligible for advanced-terminal stages. CONCLUSIONS: Age per se does not impact on short-mid-term prognosis (≤24 months) of HCC patients, and should not represent a limitation to its management.
AIMS: This multicentre cohort study evaluated the role of ageing on clinical characteristics, treatment allocation and outcome of new hepatocellular carcinomas (HCCs), in clinical practice. MATERIAL & METHODS: From September 2008, 541 patients >70 years old (elderly group), and 527 ≤70 years old (non-elderly group) with newly diagnosed HCC were consecutively enrolled in 30 Italian centres. Differences in clinical characteristics and treatment allocation between groups were described by a multivariable logistic regression model measuring the inverse probability weight to meet the elderly group. Survival differences were measured by unadjusted and adjusted (by inverse probability weight) survival analysis. RESULTS: Elderly patients were mainly females, hepatitis C virus infected and with better conserved liver function (P<.001). At presentation, HCC median size was similar in both groups while, in youngers, HCC was more frequently multinodular (P=.001), and associated with neoplastic thrombosis (P=.009). Adjusted survival analysis showed that age did not predict short-mid-term survival (within 24 months), while it was a significant independent predictor of long-term survival. Moreover, age had a significant long-term survival impact mainly on early HCC stages (Barcelona Clinic for Liver Cancer [BCLC] 0-A), its impact on BCLC B stage was lower, while it was negligible for advanced-terminal stages. CONCLUSIONS: Age per se does not impact on short-mid-term prognosis (≤24 months) of HCC patients, and should not represent a limitation to its management.