Older age but not comorbidity is associated with worse survival in patients with hepatocellular carcinoma.

Abstract

Background: Age and comorbidity are key factors in assessing patient prognosis and informing stopping rules for cancer screening eligibility, but their impact has not been rigorously evaluated in patients with hepatocellular carcinoma (HCC).

Methods: We conducted a retrospective cohort study of patients diagnosed with HCC at two health systems between January 2010 and February 2023. We used multivariable logistic regression and Cox proportional hazards models to evaluate the associations between older age (≥65 years) and comorbidity burden (Charlson Comorbidity Index) with early-stage presentation, curative treatment receipt, and overall survival. We performed subgroup analyses in patients with early-stage HCC.

Results: We identified 2002 patients with HCC (median age 61 years, 76% male, 21% early-stage), with a median survival of 15.7 months. In adjusted analyses, curative treatment receipt was associated with higher comorbidity but not older age. Conversely, overall survival was significantly associated with older age (HR 1.25, 95%CI 1.06 - 1.47) but not high comorbidity (HR 0.92, 95%CI 0.77 - 1.09). Older age continued to be associated with worse survival among patients with early-stage HCC (HR 1.99, 95%CI 1.45 - 2.73) and those who underwent curative treatment (HR 1.52, 95%CI 1.10 - 2.10). Median survival for younger vs. older individuals was 20 vs 14 months overall, 65 vs 49 months for patients with early-stage HCC, and 113 vs. 60 months for those with curative treatment.

Conclusion: Older age but not comorbidity burden is associated with worse survival in patients with early-stage HCC. Further studies are needed to define the role of comorbidity in HCC prognostication.