Liver transplantation ‘remains the standard of care’ for HCC patients, regardless of age
Despite increased perioperative risks in older patients with hepatocellular carcinoma and cirrhosis, orthotropic liver transplantation provides greater survival benefit compared with ablative therapies, according to new research.
“Because waitlist demand for [orthotopic liver transplantation (OLT)] continues to increase at a rate that far exceeds the increase in solid-organ donation, it becomes imperative to determine the optimal groups of patients that would benefit from OLT,” Malay B. Shah, MD, FACS, surgical director of the liver transplant program at UK HealthCare at the University of Kentucky, and colleagues wrote in Journal of the American College of Surgeons. “It is well known that elderly patients undergoing elective or emergent surgery have poorer outcomes compared to their younger counterparts.”
To determine whether older patients with stage I or II HCC receive a survival benefit with OLT compared with liver-directed therapy alone, Shah and colleagues analyzed data from the National Cancer Database from 2004 to 2017 and identified 2,377 patients who underwent ablative therapy and 214 patients who received OLT. Included patients were aged 70 years and older with alpha-fetoprotein values less than 500 ng/mL.
Researchers reported 1-, 3- and 5-year survival rates of 86%, 81% and 70%, respectively, for patients who received OLT compared with 82%, 51% and 31% for those who received ablation therapy. Further, they reported a 65% decreased risk for mortality with OLT compared with ablation alone (HR = 0.35, P < 0.001), as well as a correlation between patient age and a yearly 3% increase in risk for morality (HR = 1.03, P < 0.001).
Shah and colleagues wrote that the results of the study demonstrate OLT confers a significant survival advantage over ablative therapies in select older patients with HCC.
“This was the first head-to-head comparison of liver transplant vs. non-transplant outcomes for HCC in elderly patients,” Shah said in a related university release. “What we found is that patients over 70 years of age still had a very significant survival benefit from transplant compared to receiving ablative therapy alone and that transplant should still be offered to suitable elderly patients. Liver transplantation remains the standard of care for patients with HCC, regardless of age.”
Reference:
- New study shows hope, options for older patients with liver cancer. https://uknow.uky.edu/research/new-study-shows-hope-options-older-patients-liver-cancer. Published July 28, 2022. Accessed Aug. 13, 2022.
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