Influence of age on clinical presentation, therapeutic options, and prognosis in anti-HCV positive cirrhotic patients with hepatocellular carcinoma

Abstract

Background: Hepatitis C virus infection-related cirrhosis is a major risk factor for the development of hepatocellular carcinoma. Hepatocellular carcinoma in anti-hepatitis C virus positive cirrhotics shows an increasing prevalence with ageing, although it is not clear whether the age of the patients can be considered a critical factor in the overall assessment of severity of disease or in the choice of therapeutic procedures and prognosis. Objective: To evaluate the influence of older age on modality of presentation, therapeutic choices, outcome, and survival in anti-hepatitis C virus patients with hepatocellular carcinoma. Methods: We retrospectively evaluated 75 anti-hepatitis C virus positive cirrhotic patients with hepatocellular carcinoma consecutively referred to our unit. Patients were sub-divided into two sub-groups according to their age (< 65 or ≥ 65 years) at tumor diagnosis. The characteristics of the patients and of hepatocellular carcinoma, therapeutic procedures, and survival were then analyzed. Results: Median age of the patients was 68 years and mean duration of infection was 24 years. Clinical characteristics of older hepatocellular carcinoma patients were no different from those of younger ones. Hepatocellular carcinoma was more frequently of diffuse type in patients aged < 65 years. However, therapeutic options were no different between the two sub-groups of patients, and a similar proportion of patients did not undergo therapy in either group. Overall, 1- and 2-year survival rates were 73% and 51%, respectively. After a mean follow-up of 21 months a higher number of patients aged <65 years died (p=0.002). Moreover, Kaplan-Meier curves showed longer survival in patients aged ≥65 years (p=0.002). Lastly, diffuse type of hepatocellular carcinoma and tumor staging were the variables independently associated with worse survival in multivariate regression analysis. Conclusions: Hepatocellular carcinoma appears in older anti-hepatitis C virus positive cirrhotic patients showing long duration of infection. Older age of the patients does not seem to influence therapeutic options, and more importantly does not exclude patients from treatment. Lastly, older patients seem to have better prognosis most likely due to hepatocellular carcinoma characteristics, since hepatocellular carcinoma seems to present with more unfavourable characteristics in younger cirrhotic patients.