The use of hepatectomy for hepatocellular carcinoma (HCC) in older individuals has grown due to longer life expectancies and better perioperative care. However, there needs to be a specific model for estimating the safety and effectiveness of surgery. For a study, researchers sought to create a safety and efficacy-associated risk calculator for HCC in the elderly after resection (SEARCHER).

Older patients with HCC who had curative-intent hepatectomy were divided into 4 age groups: 65–69 years, 70–74 years, 75–79 years, and ≥80 years, according to data from an international multicenter database. The four groups’ short- and long-term results were compared. First, the training cohort underwent univariate and multivariate assessments of the risk variables for significant postoperative morbidity, cancer-specific survival (CSS), and overall survival (OS). Then, using the validation cohort, a nomogram-based online calculator was created and verified.

Patients in all 4 groups saw an increased risk of significant postoperative morbidity and poorer OS as they aged (P = 0.001 and 0.020, respectively) but not of postoperative mortality or CSS (P = 0.577 and 0.890). The SEARCHER model was created based on nomograms to predict significant morbidity, CSS, and OS. The model outperformed many widely-used traditional scoring and staging methods of HCC in both the training and validation populations, demonstrating good calibration and optimum performance.

The choice to conduct a hepatectomy for HCC in older individuals must be carefully reviewed due to increased potential severe postoperative morbidity and poorer OS as patients age. However, the suggested SEARCHER model performed well in predicting the safety and effectiveness of hepatectomy in older HCC patients.