Older age, not comorbidity, linked to worse survival in hepatocellular carcinoma
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Key takeaways:
- Receipt of curative treatment was associated with high comorbidity but not older age.
- Older age was associated with worse survival in early-stage disease and among treated patients.
Older age but not high comorbidity burden was significantly associated with overall survival among patients with hepatocellular carcinoma, even those with early-stage disease, according to study results.
“Patient characteristics, including age and comorbidity, can impact treatment eligibility and competing risks of mortality, thereby limiting the benefits of cancer screening,” Mounika Kanneganti, MD, an internal medicine resident at UT Southwestern Medical Center, and colleagues wrote in Clinical Gastroenterology and Hepatology. “To date, age and non-liver comorbidity have not been included in HCC screening recommendations, although one study suggested HCC screening was no longer cost-effective in patients [older than] 70 years with hepatitis C after sustained virological response.”
They continued, “Further, most studies have focused on chronological age without consideration of comorbidity burden.”
In a retrospective cohort study, Kanneganti and colleagues investigated the impact of age and comorbidity burden on tumor stage, receipt of curative treatment and overall survival in HCC. They enrolled 2,002 patients (median age, 61.3 years; 75.8% men) diagnosed with HCC between January 2010 and February 2023 at two large health centers from the North American Liver Cancer Consortium.
More than half of the population (56.9%) had liver disease etiology of hepatitis C virus, followed by alcoholic liver disease (16.3%) and metabolic dysfunction-associated steatotic liver disease (11.8%), and 20.6% had early-stage tumor burden. The most common comorbidities included a history of heavy alcohol use (53%), diabetes (29%) and peripheral vascular disease (10.1%); patients aged 65 years and older had higher comorbidity burden compared with younger patients (Charlson Comorbidity Index = 6 vs. 4).
During a median follow-up of 10.6 months, 30.4% of patients underwent curative treatment, which included a higher proportion of older vs. younger patients (36.8% vs. 27.7). Median survival was 15.7 months overall and 56.5 months among those with early-stage HCC. Younger patients demonstrated a higher median survival overall (20 months vs. 14 months), as well as when categorized by early-stage disease (65 months vs. 49 months) and receipt of curative treatment (113 months vs. 60 months).
While adjusted analyses showed receipt of curative treatment was associated with high comorbidity burden (OR = 1.47; 95% CI, 1.03-2.1) but not older age (OR = 0.93; 95% CI, 0.7-1.23), overall survival was significantly associated with older age (HR = 1.25; 95% CI, 1.06-1.47) but not high comorbidity burden (HR = 0.92; 95% CI, 0.77-1.09).
Older age remained associated with worse survival among those with early-stage disease (HR = 1.99; 95% CI, 1.45-2.73), as well as those who received curative treatment (HR = 1.52; 95% CI, 1.1-2.1).
“Older age but not comorbidity burden is associated with worse overall survival in patients with HCC, including those with early-stage HCC,” Kanneganti and colleagues wrote. “Continued studies are needed to evaluate the intersection of age and comorbidity on curative treatment eligibility and prognosis.”
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