Introduction : There are still some controversies on optimal therapeutic options for hepatocellular carcinoma(HCC) patients who were over 70 years old. This study evaluated the current status of treatment modalities for naiive elderly HCC patients in single-center to determine optimal management strategy.

Methods : From January 2014 to December 2016, we reviewed medical records of 280 naiive HCC patients over 70 years old who visited the Hepatoma Clinic in Severance Hospital, Seoul, Korea. Clinicopathological data and survival analysis were analyzed.

Results : Among these patients, 39.3% of them were Hepatitis B carrier and 75% of them had been previously diagnosed as liver cirrhosis. 65 of 280 patients(23.2%) underwent surgical resection who mostly considered as single lesion (95.4%), and all 65 patients obtained R0 resection. For the patients aged 70-75 years old, 26.9% of them underwent surgical resection, and 48.7% of them received transarterial therapy. For the patients over 80 years old, 6.7% of them underwent surgical resection, and 82.2% of them received transarterial therapy. There were statistically significant differences in selection of treatment between two groups. The overall survival and disease-free survival analysis showed a statistically significant superiority of surgical resection compared with transarterial therapy. In the propensity score matching analysis of the surgical and transarterial therapy group, there was no significant difference between the two groups in overall survival and disease-free survival.

Conclusions : Although transarterial therapy is most common treatment of choice in elderly naiive HCC patients, adequate surgical resection is another important therapeutic option to consider in achieving survival benefit in treating HCC.