Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: results from an international database
Matan J. Cohen
Division of Internal Medicine and Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorIzhar Levy
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorOrly Barak
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorAllan I. Bloom
Interventional Radiology Unit, Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorMario Fernández-Ruiz
Department of Internal Medicine, Hospital Universitario “12 de Octubre”, Instituto de Investigación “Hospital 12 de Octubre” (i + 12), Madrid, Spain
Search for more papers by this authorMassimo Di Maio
Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
Search for more papers by this authorFrancesco Perrone
Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
Search for more papers by this authorRonnie T. Poon
Department of Surgery, University of Hong Kong, Hong Kong, China
Search for more papers by this authorDaniel Shouval
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorThomas Yau
Department of Medicine and Surgery, Centre for Cancer Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
Search for more papers by this authorCorresponding Author
Oren Shibolet
Liver Unit, Department of Gastroenterology and Liver Disease, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Tel-Aviv, Israel
Correspondence
Oren Shibolet, Liver Unit, Department of Gastroenterology, Tel Aviv Sourasky Medical Center & The Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
Tel: +972 3 6973 984
Fax: +972 3 6966 286
e-mail: [email protected]
Search for more papers by this authorMatan J. Cohen
Division of Internal Medicine and Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorIzhar Levy
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorOrly Barak
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorAllan I. Bloom
Interventional Radiology Unit, Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorMario Fernández-Ruiz
Department of Internal Medicine, Hospital Universitario “12 de Octubre”, Instituto de Investigación “Hospital 12 de Octubre” (i + 12), Madrid, Spain
Search for more papers by this authorMassimo Di Maio
Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
Search for more papers by this authorFrancesco Perrone
Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
Search for more papers by this authorRonnie T. Poon
Department of Surgery, University of Hong Kong, Hong Kong, China
Search for more papers by this authorDaniel Shouval
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorThomas Yau
Department of Medicine and Surgery, Centre for Cancer Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
Search for more papers by this authorCorresponding Author
Oren Shibolet
Liver Unit, Department of Gastroenterology and Liver Disease, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Tel-Aviv, Israel
Correspondence
Oren Shibolet, Liver Unit, Department of Gastroenterology, Tel Aviv Sourasky Medical Center & The Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
Tel: +972 3 6973 984
Fax: +972 3 6966 286
e-mail: [email protected]
Search for more papers by this authorAbstract
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.
Supporting Information
| Filename | Description |
|---|---|
| liv12486-sup-0001_TableS1-S5_FigS1-13.docWord document, 508.5 KB | Fig. S1. Crude survival curve for patients older than 65. Fig. S2. Stratum: Child = Child A. Fig. S3. Stratum: Child = Child B. Fig. S4. Stratum: Child = Child C. Fig. S5. Stratum: Okuda = OKUDA I. Fig. S6. Stratum: Okuda = OKUDA II. Fig. S7. Stratum: Okuda = OKUDA III. Fig. S8. Stratum: CLIP_group = .00. Fig. S9. Stratum: CLIP_group = 1.00. Fig. S10. Stratum: CLIP_group = 2.00. Fig. S11. Stratum: CLIP_group = 3.00 and higher. Fig. S12. Crude survival curve for patients diagnosed with HCC before 2000. Fig. S13. Crude survival curve for patients diagnosed with HCC since 2000. Table S1. Cross-tabulation of Age group and Child score. Table S2. Cross-tabulation of Age group and OKUDA stage. Table S3. Cross-tabulation of Age group and CLIP score. Table S4. Survival probabilities of separate data sets and total database. Table S5. Means and Medians for Survival Time (in months). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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