Abstract
Background: Orthotopic liver transplantation (OLT) is the accepted treatment in patients with unresectable, early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. Due to increasing waitlist demand for OLT, determining optimal groups for transplant is critical. Elderly patients are known to have poorer postoperative outcomes. Considering the effectiveness of liver-directed therapies for HCC, we sought to determine whether elderly patients received survival benefit from OLT over liver-directed therapy alone. Study Design: The National Cancer Database participant use file was used to analyze data between 2004 and 2017. Only patients ≥70 years of age who received OLT or liver-directed therapy alone were included. Patients with alpha-fetoprotein >500 ng/mL or missing alpha-fetoprotein values were excluded. Baseline demographic variables, model for end-stage liver disease score, and overall survival from time of diagnosis were collected. Descriptive statistics, Kaplan-Meier survival, Cox proportional hazards model, and propensity score matching were used. Results: A total of 2,377 patients received ablative therapy alone, and 214 patients received OLT. Multivariable analysis and Kaplan-Meier showed that OLT conferred a significant survival benefit compared to liver-directed therapy alone. Age was also associated with a yearly 3% increase in risk of mortality. Propensity-matched analysis adjusting also demonstrated a significant survival benefit for elderly patients receiving OLT compared to liver-directed therapy alone. Conclusion: Despite increased age and associated comorbidities being factors associated with poor outcomes, OLT confers a survival advantage compared to liver-directed ablative therapies alone in selected elderly patients with HCC. OLT should be offered in medically appropriate elderly patients with HCC.
Original language | English |
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Pages (from-to) | 892-899 |
Number of pages | 8 |
Journal | Journal of the American College of Surgeons |
Volume | 234 |
Issue number | 5 |
DOIs | |
State | Published - May 1 2022 |
Bibliographical note
Publisher Copyright:© 2022 by the American College of Surgeons.
Funding
The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used are derived from a deidentified NCDB participant use file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods or the conclusions drawn from these data by the investigators.
Funders | Funder number |
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New Jersey Commission on Cancer Research | |
NCDB | |
American Cancer Society | |
American College of Surgeons |
ASJC Scopus subject areas
- General Medicine