老年肝细胞癌的治疗现状与前沿进展

Treatment Status and Advances of Hepatocellular Carcinoma in the Elderly

摘要: 在全球老龄化进程加速的背景下，老年癌症患者的数量预计将持续增长。肝细胞癌(HCC)多继发于慢性乙型或丙型肝炎病毒感染，或酒精性肝病等基础肝病，其发病风险具有明显的年龄相关性，因此在老年群体中并不少见。然而，许多老年患者往往未能接受针对恶性肿瘤的标准治疗。这一现象常源于一种普遍观念，即认为老年患者从积极治疗中获益有限，同时对其潜在治疗毒性的担忧也限制了治疗决策。目前，针对老年HCC患者治疗策略的综合研究数据仍较为缺乏，且现有肝癌管理指南中也缺乏专门基于年龄的分层治疗建议。因此，系统性地评估老年HCC患者接受各类治疗的安全性和临床结局显得尤为迫切。本综述旨在总结当前关于老年肝癌患者在接受不同治疗方式(包括手术切除、肝移植局部消融、经动脉化疗栓塞术和分子靶向治疗)时的临床特征及疗效结果，以期为临床实践提供参考。

Abstract: Against the backdrop of a rapidly aging global population, the number of elderly cancer patients is expected to continue rising. Hepatocellular carcinoma (HCC) often develops secondary to underlying liver conditions such as chronic hepatitis B or C virus infection or alcohol-related liver disease. Its incidence is clearly age-dependent, making it relatively common among the elderly. However, many older patients often do not receive standard treatments for malignant tumors. This phenomenon frequently stems from a widespread perception that elderly patients have limited benefits from aggressive therapy, coupled with concerns over potential treatment toxicities that influence clinical decision-making. Currently, comprehensive data on treatment strategies specifically for elderly HCC patients remains scarce, and existing liver cancer management guidelines lack age-specific recommendations. Therefore, there is an urgent need to systematically evaluate the safety and clinical outcomes of various treatments in elderly HCC patients. This review aims to summarize current knowledge regarding the clinical characteristics and efficacy outcomes of older HCC patients undergoing different treatment modalities, including surgical resection, liver transplantation, local therapy, Transarterial Chemoembolization and molecularly targeted therapy, in order to provide a reference for clinical practice.