The impact of age on the survival outcomes of hepatocellular carcinoma patients after transarterial chemoembolization: A systematic review and meta-analysis

Abstract

Background & objective: The efficacy of transarterial chemoembolization (TACE) in different populations of hepatocellular carcinoma (HCC) patients is still unclear. This meta-analysis explores the impact of TACE on survival outcomes in elderly versus younger patients with HCC, considering regional variations and heterogeneity among studies.

Methods: Nineteen studies involving 30,093 participants were systematically reviewed from January 1964 to January 2024. Data were pooled using random-effects models to calculate hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) for overall survival and survival rates, respectively. Subgroup analyses were conducted based on age cut-offs and geographical regions to assess the effect of these variables on treatment outcomes.

Results: Pooled HR for overall survival did not show a significant difference between elderly and younger patients (HR = 1.00; 95% CI: 0.98 to 1.02), with similar findings for survival rates (OR = 0.82; 95% CI: 0.46 to 1.45). Substantial heterogeneity was observed (I² = 78.0% for HR and 94.3% for OR), with notable regional differences indicating lower survival odds in European studies compared to Asian ones. No significant effect (OR = 0.95) was detected in prospective studies, while retrospective studies indicated a significant reduction in survival rates in elderly patients (OR = 0.35).

Conclusion: TACE appears to be equally effective in elderly and younger HCC patients. However, significant regional differences and study heterogeneity suggest the need for personalized treatment approaches. Further research is required to understand the underlying causes of these variations and to optimize TACE protocols.

Keywords: Hepatocellular carcinoma; Meta-Analysis; Older adults; Transarterial chemoembolization.

Fig.1

PRISMA flowchart.

Fig.2

Forest plot showing the difference in overall survival (in terms of Hazard ratio) between young and elderly hepatocellular carcinoma patients undergoing transarterial chemoembolization.

Fig.3

Forest plot showing the difference in overall survival rates (in terms of dichotomous outcomes) between young and elderly hepatocellular carcinoma patients undergoing transarterial chemoembolization.

Fig.4

Forest plot showing the difference in duration of survival between young and elderly hepatocellular carcinoma patients undergoing transarterial chemoembolization

Fig.5

Forest plot showing the difference in treatment related adverse events or complications (Grade-III or above) between young and elderly hepatocellular carcinoma patients undergoing transarterial chemoembolization.