Okamura Yukiyasu, Sugiura Teiichi, Ito Takaaki, Yamamoto Yusuke, Ashida Ryo, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan,
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Eur Surg Res. 2018;59(5-6):380-390. doi: 10.1159/000494733. Epub 2018 Dec 14.
With aging populations increasing in developed countries, the prevalence of elderly patients with hepatocellular carcinoma (HCC) is expected to rise. The aim of this study was to determine the short- and long-term outcomes of HCC surgery in elderly patients (≥75 years) using propensity score matching.
The study group included 421 patients who underwent hepatectomy as their initial treatment with curative intent. The patients were divided into elderly (n = 111) and non-elderly (n = 310) groups. We applied propensity score matching - taking into consideration patient background, blood examination, and tumor factors - to minimize the effect of potential confounders. We then compared the results before and after the propensity matching.
Before propensity matching, the elderly group included significantly more patients with a high American Society of Anesthesiologists physical status (p < 0.001). In addition, they were taking antihypertensive drugs or an anticoagulant (both p < 0.001). The severe postoperative complications and the overall survival rates for these elderly patients were significantly poorer than for the non-elderly patients (p = 0.015 and p = 0.030, respectively). We then chose 70 patients from each group for whom the preoperative confounding factors were balanced and compared the two groups. The factors identified before matching (severe complications and overall survival rates) were no longer relevant, i.e. there were no significant differences between the two groups.
Hepatectomy for HCC in elderly patients is justified.
随着发达国家老龄化人口的增加，老年肝细胞癌（HCC）患者的患病率预计将会上升。本研究的目的是使用倾向评分匹配法来确定老年患者（≥75岁）肝癌手术的短期和长期结果。
研究组包括421例行肝切除术作为初始根治性治疗的患者。患者被分为老年组（n = 111）和非老年组（n = 310）。我们应用倾向评分匹配法——考虑患者背景、血液检查和肿瘤因素——以尽量减少潜在混杂因素的影响。然后我们比较了倾向匹配前后的结果。
在倾向匹配前，老年组中美国麻醉医师协会身体状况评分高的患者明显更多（p < 0.001）。此外，他们正在服用降压药或抗凝剂（两者p < 0.001）。这些老年患者的严重术后并发症和总生存率明显低于非老年患者（分别为p = 0.015和p = 0.030）。然后我们从每组中选择了70例术前混杂因素得到平衡的患者，并比较了两组。匹配前确定的因素（严重并发症和总生存率）不再具有相关性，即两组之间没有显著差异。
老年患者肝癌肝切除术是合理的。
