Microwave ablation of hepatocellular carcinomas in octogenarians

Abstract

Aim: To evaluate wether it is safe and meaningful to treat octogenarians with microwave ablation for hepatocellular carcinoma. With an ageing population being healthier than previous generations, old limits for treating disease founded on patient age need to be revised. One of the most common tumour related death causes is hepatocellular carcinoma (HCC). With the development of minimally invasive therapies with curative potential, new ground is being broken offering treatments to older patients in the hope of achieving prolongation and better quality of life.

Methods: In this retrospective single centre study of patients having a first microwave ablation therapy for HCC in a national referral centre for ablative liver treatments, septuagenarians (n = 161, age 70-80) were compared with octogenarians (n = 32, age 80-90).

Results: Octogenarians selected for microwave ablation of HCC at a regional multidisciplinary team conference have similar outcomes as their younger control group. Survival, complications and length of stay are not different.

Conclusion: Octogenarians who are fit for ablative treatment of HCC should not be disqualified on grounds of age, recognising that this group has an obvious immortality, or lead-time, bias as well as a probable selection bias in part explaining their good results.

Keywords

Microwave / ablation / hepatocellular carcinoma / octogenarians / survival / complications

References

[1] Cancer today. Available from: http://gco.iarc.fr/today/home [Last accessed on 6 Mar 2020]

[2] Roser M. Life Expectancy. Our World in Data 2013. Available from: https://ourworldindata.org/life-expectancy [Last accessed on 6 Mar 2020]

[3] Femårig livslängdstabell för hela riket efter kön och ålder. År 1998-2002-2014-2018-Statistikdatabasen. Statistikdatabasen. Available from: http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START_BE_BE0101_BE0101I/LivslangdFemarigA/ [Last accessed on 6 Mar 2020]

[4] Aquina CT,Tejani MA,Xu Z.The impact of age on complications, survival, and cause of death following colon cancer surgery..Br J Cancer2017;116:389-97 PMCID:PMC5294480

[5] Leal JN,Gonen M,Kingham TP.Operative morbidity and survival following hepatectomy for colorectal liver metastasis in octogenarians: a contemporary case matched series..HPB (Oxford)2017;19:162-9 PMCID:PMC5608029

[6] Cho E,Jun CH,Cho SB.A review of hepatocellular carcinoma in elderly patients focused on management and outcomes..In Vivo2019;33:1411-20 PMCID:PMC6755010

[7] Zarour LR,Walker BS,Orloff SL.Hepatic resection of solitary HCC in the elderly: a unique disease in a growing population..Am J Surg2019;217:899-905

[8] Okamura Y,Ito T,Ashida R.The short- and long-term outcomes in elderly patients with hepatocellular carcinoma after curative surgery: a case-controlled study with propensity score matching..Eur Surg Res2018;59:380-90

[9] Zhao LY,Xiang X,Zheng MH.Hepatic resection for elderly patients with hepatocellular carcinoma: a systematic review of more than 17,000 patients..Expert Rev Gastroenterol Hepatol2018;12:1059-68

[10] Shen X,Tang X,Qi X.Clinical outcome in elderly Chinese patients with primary hepatocellular carcinoma treated with percutaneous microwave coagulation therapy (PMCT): a Strobe-compliant observational study..Medicine2018;97:e11618 PMCID:PMC6393083

[11] Zhang F,Sun H,Xia F.Radiofrequency ablation of hepatocellular carcinoma in elderly patients fitting the Milan criteria: a single centre with 13 years experience..Int J Hyperthermia2014;30:471-9

[12] Schullian P,Silva MA,Kolbitsch C.Stereotactic Radiofrequency ablation of liver tumors in octogenarians..Front Oncol2019;9:929 PMCID:PMC6761359

[13] Glassberg MB,Clymer JW,Ferko NC.Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis..Onco Targets Ther2019;12:6407-38 PMCID:PMC6698169

[14] Beermann M,Engstrand J,Karlgren S.1000 consecutive ablation sessions in the era of computer assisted image guidance - Lessons learned..Eur J Radiol Open2019;6:1-8 PMCID:PMC6282637

[15] Gällande vårdprogram levercellscancer - RCC. Available from: https://www.cancercentrum.se/samverkan/cancerdiagnoser/lever-och-galla/vardprogram/gallande-vardprogram-levercellscancer/ [Last accessed on 6 Mar 2020]

[16] Purysko AS,Coppa CP,Thupili CR.LI-RADS: a case-based review of the new categorization of liver findings in patients with end-stage liver disease..Radiographics2012;32:1977-95

[17] Kvalitetsregister - Väst. Available from: https://www.cancercentrum.se/vast/cancerdiagnoser/lever-och-galla/kvalitetsregister/ [Last accessed on 6 Mar 2020]

[18] Clavien PA,de Oliveira ML,Dindo D.The clavien-dindo classification of surgical complications..Ann Surg2009;250:187-96

[19] Massarweh NN,Yeung RSW.Comparative assessment of the safety and effectiveness of radiofrequency ablation among elderly medicare beneficiaries with hepatocellular carcinoma..Ann Surg Oncol2012;19:1058-65 PMCID:PMC3264841

[20] Takahashi H,Kawazoe S,Kawaguchi Y.Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients..Hepatol Res2010;40:997-1005

[21] Ettårig livslängdstabell för hela riket efter kön och ålder. År 1960-2018-Statistikdatabasen. Statistikdatabasen. Available from: http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START_BE_BE0101_BE0101I/LivslangdEttariga/ [Last accessed on 6 Mar 2020]