Original Article Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients Hirokazu Takahashi, 1 Toshihiko Mizuta, 1 Seiji Kawazoe, 2 Yuichiro Eguchi, 1 Yasunori Kawaguchi, 1 Taiga Otuka, 2 Satoshi Oeda, 2 Keisuke Ario, 2 Shinji Iwane, 1 Takumi Akiyama, 2 Iwata Ozaki 1 and Kazuma Fujimoto 1 1 Department of Internal Medicine, Saga Medical School, and 2 Department of Hepatology, Saga Prefectural Hospital, Saga, Japan Aim: This study was conducted to evaluate the efficacy and safety of radiofrequency ablation (RFA) therapy in elderly patients with hepatocellular carcinoma (HCC). Methods: Four hundred and sixty-one patients with naïve HCC, including 107 elderly (aged 375 years) patients, who were treated with RFA between 2000 and 2007, were enrolled. Baseline characteristics, survival/recurrence rates and complications after RFA were compared between elderly and non-elderly patients. Results: In the elderly group, the proportion of men, alcohol consumption, serum alanine aminotransferase and g-glutamyl transpeptidase levels were significantly lower compared with those in the non-elderly group. There were no differences in Child–Pugh grade and tumor characteristics between the two groups. The cumulative survival rates in the elderly group were 82% at 3 years and 61% at 5 years, which was equivalent to the non-elderly group. Similarly, no differences were observed in recurrence rates. In multivariate analysis, Child– Pugh grade and tumor-related factors were significant factors associated with survival, but age was not. Although elderly patients had more extrahepatic comorbidities, their presence was not a factor associated with survival prognosis or com- plication after RFA. Conclusion: RFA treatment might be safe and effective in elderly patients, as well as non-elderly patients, with HCC. Key words: elderly patients; hepatocellular carcinoma; radiofrequency ablation; survival rate. INTRODUCTION H EPATOCELLULAR CARCINOMA (HCC) is one of the most common malignancies worldwide. Hepatitis C virus (HCV) infection is the major cause of HCC in Europe, the USA and Japan. 1–3 Among HCC patients investigated between 1992 and 2000, over 70% were HCV-positive. In addition, the proportion of elderly HCC patients is increasing and the average patient age in Japan is rising. 4,5 The aging of patients with HCV is the most significant reason for the increas- ing number of elderly patients with HCC. 6 These trends have led to a rising demand for studies of HCC treat- ment in elderly patients. Current options for the treatment of HCC consist of surgical resection, transcatheter arterial embolization and percutaneous ablation therapy. Although surgical resection had been considered to be the first choice of treatment, 7,8 it plays a limited role in the treatment of HCC because underlying cirrhosis or multiple lesions often contradict surgery. Liver transplantation may be effective in some cases, 9 but its feasibility is restricted by the shortage of organ donors. Among various non- surgical therapies, radiofrequency ablation (RFA) was recently introduced and its use has been rapidly increas- ing worldwide. 10–12 RFA therapy for early stage HCC is minimally invasive and highly curative and is a standard treatment along with hepatic resection. 13 Elderly patients have a high incidence of comorbid illnesses and are usually considered a high-risk group for major surgery. 14,15 RFA treatment may therefore be an acceptable alternative. Because few studies have addressed the outcome of RFA in elderly patients with HCC, we undertook a retrospective cohort study of 107 Correspondence: Dr Toshihiko Mizuta, Department of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan. Email: mizutat@med.saga-u.ac.jp Received 6 May 2010; revision 3 June 2010; accepted 14 June 2010. Hepatology Research 2010; 40: 997–1005 doi: 10.1111/j.1872-034X.2010.00713.x © 2010 The Japan Society of Hepatology 997