Clinical outcome of radiofrequency ablation in patients with hepatocellular carcinoma aged 80 years and older

Abstract

Background and aim The incidence of hepatocellular carcinoma (HCC) is positively correlated with age, and the population of patients with HCC was also older at the time of clinical diagnosis. In the SURF trial, elderly people aged ≥80 years were excluded. We aimed to study the efficacy and safety of radiofrequency ablation (RFA) for patients aged over 80 years. Methods Patients who underwent RFA at our institution for the initial treatment of HCC tumors with largest diameters of ≤3 cm, and ≤3 HCC nodules from January 2011 to December 2023. Treatment outcomes and prognoses were examined in the elderly group (≥80 years) and in the nonelderly group (<80 years). The Cox proportional hazards model was used to determine the factors associated with treatment outcomes and prognoses. Results Of the 518 eligible patients, 136 patients were aged ≥80 years. The median overall survival (OS) values were 80 (95%CI; 60–96) and 123 (95%CI; 101–nucleotide analogs (NA)) months (p = 0.021) in the elderly and nonelderly groups, respectively. For liver disease-related deaths, the median OS values were 97 (95% CI; 80–NA) and NR (95% CI; NA–NA) months (p = 0.62) in the elderly and nonelderly groups, respectively. In the multivariate analysis, factors associated with OS were ALBI grade 2 or 3 (HR, 1.67, 95%CI; 1.07–2.60), DCP ≥ 40 mAU/ml (HR, 2.08, 95%CI; 1.42–3.04), persistent hepatitis C virus (HCV) infection (HR, 5.46, 95%CI; 3.08–9.69), and nonviral liver disease (HR, 4.19, 95%CI; 2.32–7.57). The median recurrence-free survival values were 16 (95%CI; 14–22) and 26 (95%CI; 19–30) months, respectively (p = 0.023). HCC recurrence was significantly associated with the male sex (HR, 1.50, 95%CI; 1.17–1.93), elderly group (HR, 1.37, 95%CI; 1.10–1.95), ALBI grade 2 or 3 (HR, 1.39, 95%CI; 1.07–1.80), DCP ≥ 40 mAU/ml (HR, 1.41, 95%CI; 1.10–1.81), and persistent HCV infection (HR, 1.67, 95%CI; 1.30–2.15). The factors associated with liver disease-related death were ALBI grade 2 or 3 (HR, 2.17, 95% CI; 1.26–3.75), DCP ≥ 40 mAU/ml (HR, 2.33, 95% CI; 1.47–3.69), and persistent HCV infection (HR, 2.22, 95% CI; 1.39–3.56). Conclusions In RFA for tumors with diameters of ≤3 cm and ≤3 HCC nodules, age over ≥80 years was not a significant factor associated with OS or liver disease-related death. The results support that RFA would be a promising treatment option for patients with HCC patients aged ≥80 years.