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Seoung Yoon Rho,1,2 Hyun Woong Lee,2,3 Do Young Kim,2,4 Kyung Sik Kim2,5 1Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; 2The Korean Liver Cancer Association, Seoul, Korea; 3Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; 4Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; 5Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaCorrespondence: Kyung Sik KimDepartment of Surgery, Severance Hospital, Yonsei University College of Medicine, Ludlow Faculty Research Building, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, KoreaTel +82-2-2228-2100Email kskim88@yuhs.acHyun Woong LeeDepartment of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, KoreaTel +82-2-2019-3315Email LHWDOC@yuhs.acBackground: The opportunities for examining elderly patients with hepatocellular carcinoma (HCC) have increased. We investigated the treatment of HCC for elderly patients and the overall survival associated with each treatment modality.Methods: From January 2003 to December 2005 (n=578, period I) and January 2008 to December 2014 (n=2428, period II), the National Cancer Center and Korean Liver Cancer Association collected clinical data of 3006 patients with HCC aged ≥ 70 years old at 54 medical centers in Korea. We analyzed the treatment modalities and overall survival for patients with HCC aged ≥ 70 years.Results: The mean age, Child-Pugh score, and model for end-stage liver disease score and proportion of male patients were not different between period I and period II (74 years, 6.6, 10.4 and 70.1% vs 76 years, 6.2, 9.9 and 67.3%). TNM stage II and BCLC stage A were most commonly noted in periods I and II (44.3% and 49.1% vs 40.4% and 40.2%). Transarterial therapy was the most commonly used treatment modality according to age in both periods. Surgical resection was associated with significant superior overall survival compared to local ablation and transarterial therapy (p< 0.001). After propensity score matching between surgical resection and transarterial therapy in period II, surgical resection was associated with more favorable overall survival outcomes (median: 39 months vs 86 months, p< 0.001).Conclusion: Transarterial therapy was the most commonly used treatment modality for patients with HCC aged ≥ 70 years. However, surgical resection led to significantly higher overall survival rates compared to other treatment modalities.Keywords: hepatocellular carcinoma, elderly, surgical resection, transarterial therapy, local ablation therapy