Abstract
BACKGROUND & AIMS: Older adults have lower treatment eligibility and worse survival across cancer types; however, the association between age and outcomes in patients with hepatocellular carcinoma (HCC) has not been well characterized. METHODS: We performed a search of the PubMed, Ovid MEDLINE, and EMBASE databases from January 2000 to July 2022 to identify studies reporting tumor stage, curative treatment, and overall survival among patients with HCC, stratified by age. Using the DerSimonian and Laird method for a random-effects model, we calculated pooled risk ratios (RRs) for curative treatment receipt and hazard ratios (HRs) for overall survival among younger and older patients (per age thresholds in each study). RESULTS: We identified 103 studies (n = 154,152 patients) that reported outcomes in younger vs. older patients with HCC. Younger patients were more likely to undergo curative treatment (RR 1.48, 95% CI 1.24-1.77; I(2) = 99%), although few studies reported treatment among those with early-stage HCC. Younger patients had better survival than older patients (HR 0.87, 95% CI 0.83-0.92; I(2) = 89%), which was consistent in subgroups using age thresholds of <70 years (HR 0.94, 95% CI 0.89-0.99; I(2) = 78%) and <75 years (HR 0.83, 95% CI 0.70-0.98; I(2) = 79%). Younger patients also had better survival in studies of patients with early-stage HCC (HR 0.78, 95% CI 0.65-0.94; I(2) = 60%) and those undergoing curative therapy (HR 0.87, 95% CI 0.77-0.98; I(2) = 87%). CONCLUSIONS: Older patients with HCC are less likely to receive curative treatment and have worse survival than their younger counterparts. Studies to identify factors associated with worse prognosis can inform intervention targets. IMPACT AND IMPLICATIONS: Older adults have worse survival across cancer types, although there are discordant data about the association between age and clinical outcomes in patients with hepatocellular carcinoma (HCC). Lower curative treatment receipt among older patients, despite similar early-stage presentation compared with younger patients, requires future studies to identify mediators that can inform intervention strategies that can increase curative treatment use. Worse survival observed among older patients appears to be primarily driven by non-liver-related mortality; however, few studies distinguish between liver and non-liver mortality. A better understanding of the prognostic value of comorbidity burden, in addition to age, can inform clinical decisions about stopping rules for HCC surveillance as well as the potential for HCC overdiagnosis and overtreatment.