The impact of age and ageing on hepatocarcinoma surgery: Short‐ and long‐term outcomes in a multicentre propensity‐matched cohort

Abstract

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.

Treatment of hepatocellular carcinoma beyond the Milan criteria. A weighted comparative study of surgical resection versus chemoembolization

“…This result was somehow predictable since life expectancy decreases with age progression but it may also reflect the impact of age-related frailty in rescuing from long-term side effects of therapies, 17 since age-related decline in physiological reserve and functional capacity are inevitable and may negatively affect cure tolerance. The present results endorse previous memorandum on the key role of ageing in determining treatment long-term outcomes 18,19 and should motivate a more careful selection among elderly subjects.…”

Hepatectomy Versus Sorafenib in Advanced Nonmetastatic Hepatocellular Carcinoma

“…Comorbidities, as measured using the Charlson index, can significantly affect the general health status and modify the risk of mortality by impairing the patients' functional reserve and reducing the ability to recover from aggressive procedures and/or their complications. 27,28 Indeed, our results confirm the importance of comorbidities. Notwithstanding, even if comorbidities may have adversely affected the general health status of our patients, reducing the OS, liver resection was associated with better OS even in patients Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.…”

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

“…As it may be more accurate to analyze intervention-specific complications, we aimed to assess and compare the ability of CCI and CDC to predict LOS in a more homogeneous cohort, i.e., patients undergoing liver resection for HCC. This is a worthy subset of patients to be analyzed because of the probability of encountering multiple postoperative complications, for both the complexity of surgery and the patient-inherent risks, mostly related to the underlying liver function [21][22][23].…”