Characteristics and Outcomes of Elderly Hepatocellular Carcinoma Patients following Surgical Resection: Systematic Review and Meta-Analysis

Abstract

Background: Due to aging of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence-free survival (RFS), and complication rates in elderly HCC patients undergoing resection. Methods: We searched PubMed, Embase, and Cochrane databases from inception to November 10, 2020, for studies reporting outcomes in elderly (age ≥65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model. Results: We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI: 72.89-76.02), 75.54% were male (95% CI: 72.53-78.32) and 66.73% had cirrhosis (95% CI: 43.93-83.96). The mean tumor size was 5.50 cm (95% CI: 4.71-6.29) and 16.01% had multiple tumors (95% CI: 10.74-23.19). The 1-year (86.02% vs. 86.66%, p = 0.84) and 5-year OS (51.60% vs. 53.78%) between non-elderly and elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% vs. 73.26%, p = 0.11) and 5-year RFS (31.57% vs. 30.25%, p = 0.67) between non-elderly and elderly patients. There was a higher rate of minor complications (21.95% vs. 13.71%, p = 0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p = 0.43). Conclusion: These data show that OS, recurrence, and major complications after liver resection for HCC are comparable between elderly and non-elderly patients and may inform clinical management of HCC in this population.