The impact of age and ageing on hepatocarcinoma surgery: Short- and long-term outcomes in a multicentre propensity-matched cohort.
Age Factors
Aged
Aged, 80 and over
Carcinoma, Hepatocellular
/ mortality
Female
Hepatectomy
Humans
Italy
/ epidemiology
Liver Neoplasms
/ mortality
Male
Middle Aged
Neoplasm Recurrence, Local
Postoperative Complications
/ epidemiology
Prognosis
Propensity Score
Retrospective Studies
Survival Analysis
Survival Rate
/ trends
HCC
age
ageing
elderly
outcomes
potential years of life lost
surgery
survival
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
01
09
2018
revised:
31
01
2019
accepted:
04
02
2019
pubmed:
23
2
2019
medline:
22
9
2020
entrez:
22
2
2019
Statut:
ppublish
Résumé
Management of malignancy in elderly patients is challenging. We aimed to assess the impact of age and ageing on overall survival (OS), recurrence-free survival (RFS), tumour-specific survival (TSS) and potential years of life lost (PYLL) after surgery for hepatocarcinoma (HCC). Consecutive patients treated for HCC between 2005 and 2015 were evaluated. Patients were divided according to age-decade. Afterwards, elderly patients (≥75 years) were compared with patients < 75 years. A 1:1 propensity matching was used to reduce the risk of bias. Survival was estimated by Kaplan-Meier method and Cox regression analysis. Four hundred and thirty-nine patients were stratified: group 1 (age ≤ 55, n = 72), group 2 (age: 56-65, n = 133), group 3 (age: 66-74, n = 141) and group 4 (age ≥ 75, n = 93). Group 1 had the highest median PYLL (27.6, IQR 24.6-32.5) while group 4 the lowest (2.0, IQR 0-9.6; P < 0.001). Comparing elderly vs younger, there were no significant differences in terms of OS (P = 0.054), TSS (P = 0.321) and RFS (P = 0.240). Ageing was the only variable associated with post-operative complications (OR: 2.51; 95% CI: 1.23-5.13; P = 0.025) and liver-related morbidity was an independent predictor of OS. (HR 2.49, 95% CI: 1.34-4.64, P = 0.004). Ageing per se is not an absolute contraindication for liver resection, given the acceptable oncologic long-term prognosis, but the worse short-term outcomes in the elderly should induce an accurate patient selection.
Sections du résumé
BACKGROUND
Management of malignancy in elderly patients is challenging. We aimed to assess the impact of age and ageing on overall survival (OS), recurrence-free survival (RFS), tumour-specific survival (TSS) and potential years of life lost (PYLL) after surgery for hepatocarcinoma (HCC).
METHODS
Consecutive patients treated for HCC between 2005 and 2015 were evaluated. Patients were divided according to age-decade. Afterwards, elderly patients (≥75 years) were compared with patients < 75 years. A 1:1 propensity matching was used to reduce the risk of bias. Survival was estimated by Kaplan-Meier method and Cox regression analysis.
RESULTS
Four hundred and thirty-nine patients were stratified: group 1 (age ≤ 55, n = 72), group 2 (age: 56-65, n = 133), group 3 (age: 66-74, n = 141) and group 4 (age ≥ 75, n = 93). Group 1 had the highest median PYLL (27.6, IQR 24.6-32.5) while group 4 the lowest (2.0, IQR 0-9.6; P < 0.001). Comparing elderly vs younger, there were no significant differences in terms of OS (P = 0.054), TSS (P = 0.321) and RFS (P = 0.240). Ageing was the only variable associated with post-operative complications (OR: 2.51; 95% CI: 1.23-5.13; P = 0.025) and liver-related morbidity was an independent predictor of OS. (HR 2.49, 95% CI: 1.34-4.64, P = 0.004).
CONCLUSION
Ageing per se is not an absolute contraindication for liver resection, given the acceptable oncologic long-term prognosis, but the worse short-term outcomes in the elderly should induce an accurate patient selection.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
894-904Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.