Surveillance for hepatocellular carcinoma in elderly Italian patients with cirrhosis:: Effects on cancer staging and patient survival

OBJECTIVES: Surveillance of cirrhotic individuals for early detection of HCC, based on ultrasonography (US) and alpha(1)-fetoprotein (AFP) determination, is a recommended practice currently applied also to elderly patients. However, several age-related factors may jeopardize the results of surveillance in these patients. Aim of the study was to evaluate the benefit of surveillance for HCC in elderly individuals. METHODS: Multicenter retrospective study on 1,277 consecutive patients with HCC. The inclusion criteria were: underlying chronic liver disease, description of cancer stage, and modalities of its diagnosis. Among the 1,037 patients fulfilling these criteria, 363 aged greater than or equal to70 yr were considered. RESULTS: The tumor was detected during surveillance, based on US and AFP performed every 6-12 months, in 158 individuals (group 1), incidentally in 138 (group 2) and because of symptoms in 67 (group 3). Surveillance reduced the risk of dealing with an advanced cancer (odds ratio (95% Confidence Interval): 0.18 (0.09-0.37) vs group 3, and 0.29 (0.17-0.49) vs group 2). The frequency of effective treatments decreased from group 1 to group 3 (73%, 57%, and 31%, respectively). The main cause of death was HCC progression. The survival corrected for the lead time of group 1 (median: 24 months) was significantly better than the crude survival of group 3 (7 months; p = 0.003) and barely better than that of group 2 (21 months). The latter also showed a better prognosis with respect to group 3 (p = 0.018). CONCLUSIONS: Surveillance for HCC improves the survival of elderly cirrhotic patients by expanding the percentage of cancers amenable to effective treatments.