Liver Unit, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy.
Med Oncol. 2013 Mar;30(1):446. doi: 10.1007/s12032-012-0446-y. Epub 2013 Jan 10.
The incidence of hepatocellular carcinoma (HCC) is increasing worldwide and the proportion of older patients with HCC is expected to steadily rise in the next years. Sorafenib is the standard of care for patients with advanced HCC but there is a lack of detailed data on how older patients with cirrhosis tolerate this drug. Therefore, we aimed to evaluate the impact of age on the effects of sorafenib-targeted therapy in patients with HCC and cirrhosis. We analyzed a consecutive cohort of HCC patients not eligible for surgery or locoregional treatment, with Child-Pugh score ≤ 7, and an Eastern Cooperative Oncology Group performance status of 0-1, treated with sorafenib. Clinical outcomes and treatment-related adverse events (AEs) were compared between younger (< 70 years) and older (≥ 70 years) patients. Overall, 150 patients, 90 in the younger (median age 60 years) and 60 in the older (median age 72 years) group, were evaluated. Treatment duration was 4 months in both groups. The median time to progression and overall survival were longer in older than in younger group (12 vs. 8 months and 16 vs. 12 months, respectively), although the differences did not reach a statistical significance. Grade 3-4 AEs were more frequently observed in younger than in older group (15.7 vs. 9.2 %, respectively; p = .0146). In field practice, sorafenib treatment in elderly patients with cirrhosis and HCC resulted at least as effective and safe as in younger patients. However, severe AEs occurred more frequently in younger patients.
肝细胞癌 (HCC) 的发病率在全球范围内正在增加，预计未来几年 HCC 老年患者的比例将稳步上升。索拉非尼是晚期 HCC 患者的标准治疗方法，但对于肝硬化老年患者对该药物的耐受性缺乏详细数据。因此，我们旨在评估年龄对 HCC 和肝硬化患者接受索拉非尼靶向治疗效果的影响。我们分析了一组连续的 HCC 患者，这些患者不符合手术或局部治疗的条件，Child-Pugh 评分≤7，东部合作肿瘤学组表现状态为 0-1，接受索拉非尼治疗。比较了年龄较轻（<70 岁）和年龄较大（≥70 岁）患者之间的临床结果和治疗相关不良事件 (AE)。共有 150 名患者入组，其中 90 名年龄较轻（中位年龄 60 岁），60 名年龄较大（中位年龄 72 岁）。两组的治疗持续时间均为 4 个月。与年轻组相比，老年组的中位疾病进展时间和总生存期更长（12 个月比 8 个月和 16 个月比 12 个月），尽管差异没有达到统计学意义。年轻组比老年组更常观察到 3-4 级 AE（分别为 15.7%和 9.2%；p=0.0146）。在实际临床中，肝硬化和 HCC 老年患者接受索拉非尼治疗的效果至少与年轻患者一样有效和安全。然而，年轻患者更常发生严重 AE。
