Evaluation of the prognostic factors of first-time hepatectomy for hepatocellular carcinoma in patients older than 80 years of age by multicenter analysis: Hiroshima Surgical study group of Clinical Oncology (HiSCO)

Background: With the growing older adult population in developed countries, the number of older adults with cancer is also rising. Selecting appropriate treatments for these patients is challenging, owing to difficulties in assessing their tolerance to invasive surgery. This study aimed to identify the prognostic factors in octogenarians undergoing first-time hepatectomy for hepatocellular carcinoma (HCC). Methods: We enrolled 229 consecutive patients with resected HCC between 2008 and 2018, excluding three who died within 90 days post-surgery. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS) and recurrence-free survival (RFS). Results: Participants were aged 80–93 years and included 163 males and 63 females, with the majority having hepatitis C virus. Liver function was well-preserved (Child–Pugh grade A: 215; grade B: 12). Laparoscopic hepatectomy was performed in 34 patients. The following factors showed significant association with OS in the univariate analysis: age-adjusted Charlson comorbidity index (ACCI) ≥ 10, neutrophil-to-lymphocyte ratio ≥ 3, alpha-fetoprotein (AFP) > 100 ng/mL, tumor size > 50 mm, and multiple tumors. Multivariate analysis confirmed ACCI ≥ 10, AFP > 100 ng/mL, tumor size > 50 mm, and multiple tumors as independent risk factors for OS. Regarding RFS, the significant factors identified in the univariate analysis included sex, indocyanine green retention rate at 15 min > 10%, des-gamma-carboxy prothrombin > 500 mAU/mL, intraoperative bleeding, tumor size, multiple tumors, and vascular invasion. Multivariate analysis identified sex, multiple tumors, and vascular invasion as independent risk factors for RFS. Conclusions: Elevated tumor markers, multiple tumors, and ACCI ≥ 10 are risk factors for poor OS in older adults with primary HCC. Both tumor-related factors and ACCI score should be considered when selecting treatment for octogenarian patients with HCC.