Jin Ke-Min, Wang Kun, Bao Quan, Wang Hong-Wei, Xing Bao-Cai
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatobiliary and Pancreatic Surgery Unit I, Peking University Cancer Hospital & Institute, No. 52, Fu Cheng Road, Beijing, 100142, People's Republic of China.
World J Surg Oncol. 2020 Oct 24;18(1):275. doi: 10.1186/s12957-020-02055-8.
Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients.
From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥ 70 years of age) were matched to 128 younger patients (< 70 years of age) to obtain two balanced groups with regard to demographic, therapeutic, and prognostic factors.
There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score III and comorbidities and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p < 0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175 ml vs. 200 ml, p = 0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p = 0.020), and a higher readmission rate (4.7% vs.0%, p = 0.036). The EG also had longer disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p > 0.05). Old age was not an independent factor for DFS, OS, and CSS by Cox multivariate regression analysis (p > 0.05).
Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS, and CSS.
与年龄匹配的年轻患者相比，很少有研究关注肝切除术在老年结直肠癌肝局限性转移患者中的作用。
2000年1月至2018年12月，724例患者因结直肠癌肝局限性转移接受了肝切除术。基于1:2倾向评分匹配（PSM）模型，将64例老年患者（≥70岁）与128例年轻患者（<70岁）进行匹配，以获得在人口统计学、治疗和预后因素方面平衡的两组。
在未匹配队列中，有73例老年患者和651例年轻患者。与年轻组（YG）相比，老年组（EG）美国麻醉医师协会评分III级和合并症的比例显著更高，肝转移超过3处和术后化疗的比例更低（p<0.05）。对这些因素以及大鼠肉瘤病毒原癌基因/B-Raf原癌基因（RAS/BRAF）突变状态和原发肿瘤部位进行PSM后发现：EG组术中中位失血量显著少于YG组（175ml对200ml，p=0.046），术后中位住院时间更短（8天对11天，p=0.020）以及再入院率更高（4.7%对0%，p=0.036）。与YG组相比，EG组的无病生存期（DFS）、总生存期（OS）和癌症特异性生存期（CSS）也更长，但这些结果无统计学意义（p>0.05）通过Cox多因素回归分析，年龄不是DFS、OS和CSS的独立因素（p>0.05）。
肝切除术对老年结直肠癌肝局限性转移患者是安全可行的并且这些患者随后可能从延长DFS、OS和CSS中获益。
