Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Liver transplantation LT for HCC is curative but entails increased risk and is limited by organ scarcity. Alternative approaches such as locoregional therapy (LRT) or liver resection (LR) may offer comparable benefit in many clinical settings. Because of diminished life expectancy, a multimodality approach might be best in the elderly patients. We sought to quantify the survival advantage of these approaches in a cohort of elderly patients by modality: LT, LR or LRT in a large single-center 20-year experience.
*Methods: This is a single-center retrospective cohort study of all consecutive patients diagnosed with HCC at age > 65 that were treated interventionally with LT, LR or LRT between 1998 and 2018. Patients were divided into three groups based on the most invasive intervention they received. Overall survival from time of diagnosis was compared among the three treatment groups for all patients, a subgroup analysis for patients with tumor burden within Milan criteria at diagnosis was also performed.
*Results: A total of 466 patients older than 65 at time of HCC diagnosis were identified, 105 with LT, 84 LR and 277 with LRT. In the overall cohort, LT patients were at baseline younger than LR and LRT(respectively 69, 73 and 73 years, p<0.001), were most often within Milan criteria and had a higher MELD-Na (15 vs 11 and 13, p<0.001). 5-year OS was significantly higher in LT group followed by LR then LRT (respectively 70, 53 and 31%, p<0.001) (Table 1). Among patients within Milan (Table 2), LT were also younger (69 vs 73 and 73 years, p<0.001) and had significantly higher MELD-Na (16 vs 11 and 12, p<0.001). 5-year OS was significantly higher in LT and LR groups compared to LRT (respectively 69, 68 and 39%, p<0.001)
*Conclusions: Overall, liver transplantation remains the best therapeutic option for elderly patients with transplantable HCC. In patients within Milan Criteria, LR confers a similar 5-year OS as LT. Patients treated with LRT had survival below 50% at 30 months presumably reflecting selection of the least invasive therapeutic alternative. Overall survival may reflect progressive medical, hepatic and oncologic risk in this cohort and selection criteria for each therapy will require further study.
To cite this abstract in AMA style:Najjar M, Perez O, Zou J, Sun S, Bruestle K, Jiang P, Verna E, Zheng E, Saenger Y, Mathur A, Griesemer A, Samstein B, Kato T, Halazun K, Emond J. Multimodal Strategy for Hepatocellular Carcinoma in the Elderly: To Transplant or Not to Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/multimodal-strategy-for-hepatocellular-carcinoma-in-the-elderly-to-transplant-or-not-to-transplant/. Accessed November 24, 2020.
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