Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients

Results from an international database

Matan J. Cohen, Izhar Levy, Orly Barak, Allan I. Bloom, Mario Fernández-Ruiz, Massimo Di Maio, Francesco Perrone, Ronnie T. Poon, Daniel Shouval, Thomas Yau, Oren Shibolet

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Hepatocellular carcinoma (HCC) incidence among elderly patients is increasing. Trans-arterial chemo-embolization (TACE) prolongs survival in selected HCC patients. The safety and efficacy of TACE in elderly patients has not been extensively studied. The objective of this study was to assess the safety and efficacy of TACE in elderly patients (older than 75) with HCC. Design: Combined HCC registries (Spain, Italy, China and Israel) and cohort design analysis of patients who underwent TACE for HCC. Results: Five hundred and forty-eight patients diagnosed and treated between 1988 and 2010 were included in the analysis (China 197, Italy 155, Israel 102 and Spain 94,). There were 120 patients (22%) older than 75 years and 47 patients (8.6%) older than 80. Median (95% CI) survival estimates were 23 (17-28), 21 (17-26) and 19 (15-23) months (P = 0.14) among patients aged younger than 65, 65-75 and older than 75 respectively. An age above 75 years at diagnosis was not associated with worse prognosis, hazard ratio of 1.05 (95% CI 0.75-1.5), controlling for disease stage, sex, diagnosis year, HBV status and stratifying per database. No differences in complication rates were found between the age groups. Conclusions: TACE is safe for patients older than 75 years. Results were similar over different eras and geographical locations. Though selection bias is inherent, the results suggest overall adequate selection of patients, given the similar outcomes among the different age groups.

Original languageEnglish
Pages (from-to)1109-1117
Number of pages9
JournalLiver International
Volume34
Issue number7
DOIs
Publication statusPublished - 2014

Fingerprint

Hepatocellular Carcinoma
Databases
Israel
Spain
Italy
China
Age Groups
Safety
Survival
Selection Bias
Patient Selection
Registries
Cohort Studies
Incidence

Keywords

  • Elderly patients
  • Hepatocellular carcinoma
  • Trans-arterial chemo-embolization

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

Cite this

Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients : Results from an international database. / Cohen, Matan J.; Levy, Izhar; Barak, Orly; Bloom, Allan I.; Fernández-Ruiz, Mario; Di Maio, Massimo; Perrone, Francesco; Poon, Ronnie T.; Shouval, Daniel; Yau, Thomas; Shibolet, Oren.

In: Liver International, Vol. 34, No. 7, 2014, p. 1109-1117.

Research output: Contribution to journalArticle

Cohen, MJ, Levy, I, Barak, O, Bloom, AI, Fernández-Ruiz, M, Di Maio, M, Perrone, F, Poon, RT, Shouval, D, Yau, T & Shibolet, O 2014, 'Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: Results from an international database', Liver International, vol. 34, no. 7, pp. 1109-1117. https://doi.org/10.1111/liv.12486
Cohen, Matan J. ; Levy, Izhar ; Barak, Orly ; Bloom, Allan I. ; Fernández-Ruiz, Mario ; Di Maio, Massimo ; Perrone, Francesco ; Poon, Ronnie T. ; Shouval, Daniel ; Yau, Thomas ; Shibolet, Oren. / Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients : Results from an international database. In: Liver International. 2014 ; Vol. 34, No. 7. pp. 1109-1117.
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AU - Bloom, Allan I.

AU - Fernández-Ruiz, Mario

AU - Di Maio, Massimo

AU - Perrone, Francesco

AU - Poon, Ronnie T.

AU - Shouval, Daniel

AU - Yau, Thomas

AU - Shibolet, Oren

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N2 - Objective: Hepatocellular carcinoma (HCC) incidence among elderly patients is increasing. Trans-arterial chemo-embolization (TACE) prolongs survival in selected HCC patients. The safety and efficacy of TACE in elderly patients has not been extensively studied. The objective of this study was to assess the safety and efficacy of TACE in elderly patients (older than 75) with HCC. Design: Combined HCC registries (Spain, Italy, China and Israel) and cohort design analysis of patients who underwent TACE for HCC. Results: Five hundred and forty-eight patients diagnosed and treated between 1988 and 2010 were included in the analysis (China 197, Italy 155, Israel 102 and Spain 94,). There were 120 patients (22%) older than 75 years and 47 patients (8.6%) older than 80. Median (95% CI) survival estimates were 23 (17-28), 21 (17-26) and 19 (15-23) months (P = 0.14) among patients aged younger than 65, 65-75 and older than 75 respectively. An age above 75 years at diagnosis was not associated with worse prognosis, hazard ratio of 1.05 (95% CI 0.75-1.5), controlling for disease stage, sex, diagnosis year, HBV status and stratifying per database. No differences in complication rates were found between the age groups. Conclusions: TACE is safe for patients older than 75 years. Results were similar over different eras and geographical locations. Though selection bias is inherent, the results suggest overall adequate selection of patients, given the similar outcomes among the different age groups.

AB - Objective: Hepatocellular carcinoma (HCC) incidence among elderly patients is increasing. Trans-arterial chemo-embolization (TACE) prolongs survival in selected HCC patients. The safety and efficacy of TACE in elderly patients has not been extensively studied. The objective of this study was to assess the safety and efficacy of TACE in elderly patients (older than 75) with HCC. Design: Combined HCC registries (Spain, Italy, China and Israel) and cohort design analysis of patients who underwent TACE for HCC. Results: Five hundred and forty-eight patients diagnosed and treated between 1988 and 2010 were included in the analysis (China 197, Italy 155, Israel 102 and Spain 94,). There were 120 patients (22%) older than 75 years and 47 patients (8.6%) older than 80. Median (95% CI) survival estimates were 23 (17-28), 21 (17-26) and 19 (15-23) months (P = 0.14) among patients aged younger than 65, 65-75 and older than 75 respectively. An age above 75 years at diagnosis was not associated with worse prognosis, hazard ratio of 1.05 (95% CI 0.75-1.5), controlling for disease stage, sex, diagnosis year, HBV status and stratifying per database. No differences in complication rates were found between the age groups. Conclusions: TACE is safe for patients older than 75 years. Results were similar over different eras and geographical locations. Though selection bias is inherent, the results suggest overall adequate selection of patients, given the similar outcomes among the different age groups.

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