Clinical outcome of radiofrequency ablation in elderly hepatocellular carcinoma patients over 80 years old.

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Background: The SURF trial showed the efficacy and safety of radiofrequency ablation(RFA). However, patients over 80 years old were excluded from the study. Aims: To evaluate clinical outcomes of RFA for largest hepatocellular carcinoma (HCC) diameter ≤3 cm, and ≤3 HCC nodules in patients over 80 years. Methods: Patients who underwent RFA at our institution for initial treatment of largest HCC diameter ≤3 cm, and ≤3 HCC nodules from January 2011 to December 2023. Treatment outcome and prognosis were examined in the elderly group for cases 80 years or older and in the non-elderly group for cases under 80 years. The Cox proportional hazards model was used to analyze the factors associated with treatment outcome and prognosis. Results: Of the 518 eligible patients, 136 patients were 80 years or older. Median overall Survival (OS) was 80 (95%CI 60-96) vs. 123 (95%CI 101-NA) months (p=0.021) in the elderly vs. nonelderly group. The median recurrence-free survival was 16 (95%CI 14-22) vs. 26 (95%CI 19-30) months (p=0.023), better in the non-elderly group, Interestingly, for liver disease-related deaths, median OS was 97 (95% CI 80-NA) vs. NR (95% CI NA-NA) months (p=0.62) in the elderly vs. non-elderly group. In the multivariate analysis, factors associated with OS were ALBI grade 2 or 3 (HR 1.67, 95%CI 1.07-2.60), DCP ≥ 40mAU/ml (HR 2.08, 95%CI 1.42-3.05), persistent HCV infection (HCV non-SVR) (HR 5.45, 95%CI 3.07-9.67), nonviral liver disease (HR 4.18, 95%CI 2.31-7.55). HCC recurrence was significantly associated with male (HR 1.51, 95%CI 1.18-1.94), elderly group (HR 1.46,95%CI 1.10-1.95), PT ≥80% (HR 0.69, 95%CI 0.53-0.91), DCP ≥40mAU/ml (HR 1.37, 95%CI 1.07-1.76), and HCV non-SVR (HR 1.73, 95%CI 1.35-2.21). The factors associated with liver disease-related death were ALBI grade 2 or 3 (HR 2.16, 95% CI 1.25-3.73), DCP ≥ 40mAU/ml (HR 2.34, 95% CI 1.48-3.70) and HCV non-SVR (HR 2.22, 95% CI 1.39-3.56). Conclusions: In RFA for diameter ≤3 cm, and ≤3 HCC nodules, over 80 years was not a significant factor associated with OS or liver disease-related death. The results support that RFA would be a promising treatment option for HCC patients over 80 years.