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Survival and Tolerability of Transarterial Chemoembolization in Greater Versus less than 70 Years of Age Patients with Unresectable Hepatocellular Carcinoma: A Propensity Score Analysis

  • Clinical Investigation
  • Interventional Oncology
  • Published:
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Abstract

Background

The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) is progressively increasing. The aim of this study was to determine the safety and efficacy of conventional transarterial chemoembolization (TACE) in elderly HCC patients compared with younger adults.

Methods

A consecutive cohort of unresectable HCC patients treated with TACE as a first-line treatment was retrospectively analyzed. Patients were categorized into “elderly” (≥ 70 years, 80 patients) and “younger” (< 70 years, 145 patients). Liver-related death and progression-free survival after TACE were compared before and after propensity score matching. A competing risk regression analysis was used for univariate/multivariate survival data analysis.

Results

cTACE was well tolerated in both groups. The cumulative risk of both liver-related death and progression-free survival after cTACE was comparable between “elderly” and “younger” (death: 73.8% vs 69.4%, P = 0.505; progression-free survival: 48.2% vs 44.8%, P = 0.0668). Propensity model matched 61 patients in each group for gender and Barcelona Clinic Liver Cancer staging. Even after matching, the cumulative risk of liver-related death and of progression-free survival did not differ between the two groups. At multivariate analysis, Child–Pugh class, tumor gross pathology and alpha-fetoprotein were independently associated with the liver-related mortality risk.

Conclusions

This study confirms that TACE is well tolerated and effective in patients aged 70 years or more with unresectable HCC as it is for their younger counterparts (< 70 years). Liver-related mortality was not associated with age ≥ 70 years and primarily predicted by tumor multifocality, Child–Pugh class B and an increased alpha-fetoprotein value (> 31 ng/ml).

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Diagnostic Medicine and Prevention, Radiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Cristina Mosconi, Alberta Cappelli, Antonio Bruno, Caterina De Benedittis, Francesco Modestino, Giuliano Peta & Rita Golfieri

  2. Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Annagiulia Gramenzi, Maurizio Biselli, Alessandro Cucchetti, Giampaolo Bianchi & Franco Trevisani

  3. General and Oncology Surgery, Morgagni-Pierantoni Hospital, Forli, Italy

    Alessandro Cucchetti

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  1. Cristina Mosconi
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Correspondence to Annagiulia Gramenzi.

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Mosconi, C., Gramenzi, A., Biselli, M. et al. Survival and Tolerability of Transarterial Chemoembolization in Greater Versus less than 70 Years of Age Patients with Unresectable Hepatocellular Carcinoma: A Propensity Score Analysis. Cardiovasc Intervent Radiol 43, 1015–1024 (2020). https://doi.org/10.1007/s00270-020-02451-3

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