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Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: results from an international database

Authors

  • Matan J. Cohen,

    1. Division of Internal Medicine and Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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  • Izhar Levy,

    1. Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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  • Orly Barak,

    1. Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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  • Allan I. Bloom,

    1. Interventional Radiology Unit, Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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  • Mario Fernández-Ruiz,

    1. Department of Internal Medicine, Hospital Universitario “12 de Octubre”, Instituto de Investigación “Hospital 12 de Octubre” (i + 12), Madrid, Spain
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  • Massimo Di Maio,

    1. Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
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  • Francesco Perrone,

    1. Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
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  • Ronnie T. Poon,

    1. Department of Surgery, University of Hong Kong, Hong Kong, China
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  • Daniel Shouval,

    1. Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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  • Thomas Yau,

    1. Department of Medicine and Surgery, Centre for Cancer Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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  • Oren Shibolet

    Corresponding author
    1. 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: orensh@tlvmc.gov.il

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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.

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