Abstract: Introduction: The literature on liver transplantation (LT) for cirrhosis-associated hepatocellular carcinoma (cirr-HCC) in elderly patients (≥65 years of age) is scarce. The aim of this study was therefore to analyze the outcome after LT for cirr-HCC in elderly patients in our single-center experience. Methods: All consecutive patients who underwent LT for cirr-HCC at our center were identified from our prospectively collected LT database and stratified into an elderly (≥65 years) and a younger (<65 years) cohort. Perioperative mortality as well as Kaplan-Meier estimations of overall (OS) and recurrence-free survival (RFS) were compared between age strata. A sub-group analysis was performed for patients with HCC only inside Milan criteria. For further oncological comparison, outcome in the subgroup of elderly LT recipients with HCC inside Milan was also compared to a group of elderly patients undergoing liver resection for cirr-HCC inside Milan extracted from our institutional liver resection database. Results: Out of 369 consecutive patients with cirr-HCC who underwent LT between 1998 and 2022 at our center, we identified 97 elderly (with a subgroup of 14 septuagenarians) and 272 younger LT patients. 5- and 10-year OS in elderly compared to younger LT patients was 63% and 52% vs. 63% and 46% (p = 0.67), respectively, while 5- and 10-year RFS was 58% and 49% vs. 58% and 44% (p = 0.69). 5-/10-year OS and RFS in 50 elderly LT recipients with HCC inside Milan were 68%/55% and 62%/54%, respectively, which compared to 46%/38% (p = 0.07)and 26%/14% (p < 0.0001) in elderly patients after liver resection for cirr-HCC inside Milan. Discussion/Conclusion: Our results in almost 100 elderly patients after LT for cirr-HCC show that older age per se should not be considered a contraindication to LT and that selected elderly patients older than 65 and even 70 years benefit from LT as much as younger ones.


中文翻译：

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老年肝细胞癌患者与年轻患者一样受益于肝移植

摘要：简介：关于老年患者（≥65 岁）肝硬化相关肝细胞癌（cirr-HCC）的肝移植（LT）文献很少。因此，本研究的目的是根据我们的单中心经验分析老年患者 cirr-HCC LT 后的结果。方法：从我们前瞻性收集的 LT 数据库中识别出所有在我们中心因 cirr-HCC 接受 LT 的连续患者，并将其分为老年组（≥65 岁）和年轻组（<65 岁）。比较不同年龄层的围手术期死亡率以及 Kaplan-Meier 对总生存期 (OS) 和无复发生存期 (RFS) 的估计。仅对符合米兰标准的 HCC 患者进行了亚组分析。为了进一步的肿瘤学比较，米兰境内患有 HCC 的老年 LT 接受者亚组的结果也与从我们的机构肝切除数据库中提取的米兰境内因 cirr-HCC 接受肝切除术的老年患者组进行了比较。结果：在 1998 年至 2022 年期间在我们中心接受 LT 的 369 名连续 cirr-HCC 患者中，我们确定了 97 名老年人（其中包括 14 名七十多岁老人）和 272 名年轻 LT 患者。与年轻 LT 患者相比，老年 LT 患者的 5 年和 10 年 OS 分别为 63% 和 52% vs 63% 和 46% (p = 0.67)，而 5 年和 10 年 RFS 分别为 58% 和 49% vs . 58% 和 44% (p = 0.69)。米兰境内 50 名患有 HCC 的老年 LT 接受者的 5 年/10 年 OS 和 RFS 分别为 68%/55% 和 62%/54%，而 46%/38% (p = 0.07) 和 26%/ 14%（p < 0。0001）米兰境内因 cirr-HCC 肝切除术后的老年患者。讨论/结论：我们对近 100 名因 cirr-HCC 接受 LT 治疗的老年患者进行的研究结果表明，年龄较大本身不应被视为 LT 的禁忌症，并且选定的 65 岁以上甚至 70 岁以上老年患者与年轻患者一样从 LT 中获益那些。