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Page 6 of 7 Freedman. Hepatoma Res 2020;6:10 I http://dx.doi.org/10.20517/2394-5079.2019.32

Survival in the presented cohort is well comparable to results presented in a meta-analysis of elderly
[6]
patients resected for HCC by Cho et al. , but with much shorter length of stay and much fewer
complications, where, typically, resected elderly patients stay for 9-18 days in hospital and with 13%-36%
[19]
having postoperative complications. In a US study from 2012 on RFA , the postoperative mortality was
worse, as was survival with 72% surviving the first year and 39% and 34% at three and five years compared
to the present study’s 100%, 69% and 40%, respectively, for the octogenarian group, numbers that are
[20]
somewhat inferior to what Takahashi et al. presented. Numbers are difficult to compare as underlying
causes of HCC and expected life span varies greatly among the US, Japan and Sweden.

In the present study, the mean age in the older cohort was 82 with a median survival of 4.3 years and the
younger cohort with a mean age of 74 had a median survival of 3.9 years. This is considerably shorter than
[21]
the average life expectancy for a 74-year-old (13 years) or an 82-year-old (8 years) in Sweden .
Selection bias is an obvious disadvantage when analysing this kind of dataset. Associated liver disease and
hepatitis C was more prevalent in the younger group.

The small size of the octogenarian cohort could easily mask a Type 2 error. On the other hand, there is the
obvious problem with immortality bias as the octogenarians have by necessity survived until 80 and are
thus a selected group with a slightly higher life expectancy. This could perhaps in part explain the excellent
three-year survival of 100% in that cohort.

In conclusion, as the population steadily has a greater life expectancy, the indications for treating tumours
in older and healthier age groups becomes necessary. The results of the present study indicate that ablating
hepatocellular carcinomas in octogenarians can safely be performed with good results if no obvious
contraindication is present.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
The data source is a local prospective database where all microwave ablations has been recorded since june
2010.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
This retrospectiv study was approved by the regional ethics board in preparation of a previous study.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.