Revista Espanola de Enfermedades Digestivas (Oct 2008)
Carcinoma hepatocelular en el anciano: características clínicas, análisis de supervivencia y factores pronósticos en una cohorte de pacientes españoles mayores de 75 años Hepatocellular carcinoma in the elderly: clinical characteristics, survival analysis, and prognostic indicators in a cohort of Spanish patients older than 75 years
Abstract
Objetivos: el carcinoma hepatocelular (CHC) permanece mal caracterizado en pacientes de edad avanzada y comorbilidad, circunstancia que limita su manejo clínico. Pretendemos analizar la historia natural del CHC en mayores de 75 años y determinar los factores que condicionan su supervivencia. Pacientes y métodos: análisis retrospectivo de 235 pacientes con CHC categorizados según su edad al diagnóstico: ≤ 75 años (n = 186) y > 75 años (n = 49). Tras comparar sus variables clínicas (χ² y t-Student), realizamos un análisis de regresión logística para determinar los factores asociados a la recepción de tratamiento locorregional (vs. sintomático); la supervivencia entre ambos grupos fue comparada mediante el test de log-rank, con posterior análisis multivariante (modelo de riesgos proporcionales de Cox). Resultados: no se obtuvieron diferencias entre ambos grupos en su distribución por sexo, presencia de cirrosis, etiología, Child-Pugh, estadio BCLC, ascitis, trombosis portal, o valores de bilirrubina, AST, ALT, γGT, LDH o hematocrito. Los pacientes de edad avanzada fueron mαs frecuentemente diagnosticados en presencia de manifestaciones clνnicas, con enfermedad multifocal, no localizada, y niveles de α-fetoproteνna > 400 ng/ml (todas, p 75 años actuó como predictor de la no recepción de terapia locorregional (p Aims: hepatocellular carcinoma (HCC) remains poorly characterized in elderly patients with comorbid conditions, a fact that limits the clinical management of the disease. This study analyzes the natural history of HCC in patients older than 75, and determines factors that condition their survival. Patients and methods: a retrospective analysis of 235 patients with HCC divided into 2 groups by age at diagnosis: ≤ 75 (n = 186) and > 75 (n = 49). After comparing their clinical variables (χ² and t test), a logistic regression analysis was performed to determine factors associated with receiving locoregional treatment (versus symptomatic treatment). Survival in the 2 groups was compared using a log rank test with subsequent multivariate analysis (Cox proportional hazards model). Results: there were no differences between groups for sex, presence of cirrhosis, etiology, Child-Pugh score, BCLC stage, presence of ascites or portal thrombosis, or bilirubin, AST, ALT, γGT, LDH or hematocrit values. Patients of advanced age were more frequently diagnosed in the presence of clinical manifestations, and had multifocal, non-localized disease and a-fetoprotein levels > 400 ng/mL (all p < 0.05). This group received exclusively symptomatic treatment in 78% of cases (compared to 33% in younger patients), and only 3 of them underwent surgical resection (p < 0.0001). Age older than 75 was a predictive factor for not receiving locoregional therapy (p < 0.0001). Survival in the elderly group (9.8 ± 1 months) differed substantially from that of younger patients (25.6 ± 2 months) (p < .00001). Advanced age continued to be a prognostic factor of poor survival in the multivariate analysis (p = 0.025), but lost significance when the analysis was stratified by treatment subgroups (p = 0.344). Conclusions: the lower survival seen in elderly patients with HCC, beyond differences in tumor extension or liver failure, seems conditioned by the use of suboptimal treatment in this population.
