Bell Richard, Pandanaboyana Sanjay, Nisar Saira, Upasani Vivek, Toogood Giles, Lodge J Peter, Prasad K Raj
Department of Hepatobiliary and Transplant Surgery, St James University Hospital, ICU Offices, Level 3 Bexley Wing, Leeds, LS9 7TF, UK.
Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand.
J Gastrointest Surg. 2017 Feb;21(2):266-274. doi: 10.1007/s11605-016-3296-7. Epub 2016 Oct 21.
This study analysed the effect of age on survival in patients undergoing major hepatectomy (MH) for colorectal liver metastases (CRLM). The effect of adjuvant chemotherapy (AC) with age was also assessed.
Patients undergoing MH for CRLM between 1996 and 2011 were reviewed. Patients aged <75 or ≥75 were compared for disease-free (DFS) and overall survival (OS) as well as impact of AC on survival.
Seven hundred twenty-seven patients underwent MH of which 105 (14 %) were aged ≥75. Morbidity was greater in the ≥75 group (25 versus 34 %, p = 0.048). No difference was noted in mortality. There was no difference in DFS between the two groups at 5 years (16.8 vs 18.9 months (p = 0.570). OS was longer in the <75 group (38.6 vs 32.0 months (p = 0.001). DFS was better in groups receiving AC than those not (<75 24.2 vs 12.2 months (p = <0.001) and ≥75 24 vs 12.1 months (p = 0.007)). OS in the ≥75 group was improved in the group receiving AC compared to the ≥75 group not (41.1 vs 16.6 months, p = 0.005). Age ≥75 was not an independent risk factor for reduced DFS on multivariate analysis.
Well-selected patients aged ≥75 should be considered for MH followed by adjuvant chemotherapy.
本研究分析了年龄对接受结直肠癌肝转移（CRLM）大肝切除术（MH）患者生存的影响。同时评估了辅助化疗（AC）与年龄对生存的影响。
回顾了1996年至2011年间接受CRLM的MH患者。比较了年龄＜75岁或≥75岁患者的无病生存期（DFS）和总生存期（OS），以及AC对生存的影响。
727例患者接受了MH，其中105例（14%）年龄≥75岁。≥75岁组的发病率更高（25%对34%，p = 0.048）。死亡率无差异。两组5年DFS无差异（16.8对18.9个月（p = 0.570））。＜75岁组的OS更长（38.6对32.0个月（p = 0.001））。接受AC组的DFS优于未接受AC组（＜75岁组24.2对12.2个月（p ＜0.001），≥75岁组24对12.1个月（p = 0.007））。与未接受AC的≥75岁组相比，接受AC的≥75岁组的OS有所改善（41.1对16.6个月，p = 0.005）。多因素分析显示，年龄≥75岁不是DFS降低的独立危险因素。
经过精心挑选的年龄≥75岁的患者应考虑接受MH及辅助化疗。
