Hepatocellular Carcinoma Management in Elderly Patients

Hepatocellular carcinoma in patients aged 65 years and above presents unique challenges owing to age-related physiological decline, comorbidities and altered tumour biology. Elderly individuals often exhibit reduced hepatic reserve, cardiovascular and renal comorbidities, and a higher prevalence of metabolic dysfunction. Early detection remains uncommon, resulting in diagnosis at intermediate or advanced stages. Treatment selection must balance efficacy against tolerability, taking account of liver function, performance status and patient preferences. Curative options such as surgical resection, radiofrequency ablation and transplantation are effective in well selected elderly patients but may be limited by comorbidity burden. Locoregional therapies, notably transarterial chemoembolization, serve as cornerstone treatments for intermediate disease, while systemic agents, including targeted therapies and immunotherapies, have increasingly been evaluated in older cohorts. A personalised approach that integrates geriatric assessment, tumour staging and multidisciplinary input is essential to optimise outcomes in this growing population.

Research from Nature Portfolio

A large nationwide registry study in Korea has characterised current treatment patterns and natural prognosis in hepatocellular carcinoma patients aged 65 years or older. It revealed that nearly 70% of elderly patients receive active interventions, with transarterial chemoembolization being most common, followed by resection and ablation. Uptake of supportive care rises with advancing age. Among first-line options, liver transplantation conferred the greatest survival advantage, although its utilisation in older groups remains low. Second-line therapies were underused, with only one third of patients receiving further interventions. These findings underscore the need for tailored decision-making and strategies to improve access to curative modalities in the elderly.

Hepatocellular Carcinoma Management in Elderly Patients publication trend

The graph below shows the total number of articles in hepatocellular carcinoma management in elderly patients across all publications each year (not limited to Nature Index journals).

Technical terms

Transarterial chemoembolization: A locoregional procedure delivering chemotherapy and embolic particles directly into the hepatic artery to induce tumour ischaemia and cytotoxicity.

Radiofrequency ablation: A minimally invasive technique in which thermal energy is applied via needle electrodes under imaging guidance to destroy tumour tissue.

Surgical resection: The surgical excision of a liver segment or lobe containing the tumour, offering potential cure in early-stage disease.

Liver transplantation: Replacement of the diseased liver with a donor organ, indicated for select patients with limited tumour burden and preserved performance status.

BCLC staging system: A classification that integrates tumour stage, liver function and patient performance to guide treatment of hepatocellular carcinoma.

References

1. A nationwide study on the current treatment status and natural prognosis of hepatocellular carcinoma in elderly. Scientific Reports (2023).
2. Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Current Oncology (2024).
3. Impact of aging on primary liver cancer: epidemiology, pathogenesis and therapeutics. Aging (2021).