The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: Hepatectomy for HCC in elderly patients is justified.

Surgical Resection Is Superior to TACE in the Treatment of HCC in a Well Selected Cohort of BCLC-B Elderly Patients—A Retrospective Observational Study

“…Several reports from the USA, UK, and Japan showed a significant age-specific increase in HCC development among persons over 70 years old [ 60 , 61 ]. From recent studies evaluating the clinical characteristics of elderly patients, it emerged that elders have less liver tissue fibrosis and fewer HCC nodules than younger patients [ 62 , 63 , 64 ].…”

New landscapes and horizons in hepatocellular carcinoma therapy

“…Several studies have demonstrated that there are no substantial differences in complications among younger and elderly patients when the populations are correctly selected according to the guidelines [240][241][242][243][244][245][246][247][248][249], although some studies have reported a Grade 2 and 3 of complications according to the Clavien-Dindo classification [247,248].…”

Short-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma in older patients: a propensity score matching analysis

“…Therefore, older patients are more likely to have occlusive events, and their operative course needs closer attention than those of younger patients. Nonetheless, several reports have indicated that OLR for older patients with HCC is safe and feasible [ 12 – 14 ]. Conversely, the benefits of laparoscopic surgery for older patients with HCC remain controversial.…”

“…Limited studies have been conducted to evaluate the risk of surgical complications or the safety and efficacy of LLR for HCC in older patients [ 14 – 16 ]. Thus, this study aimed to examine the safety and feasibility of LLR for HCC in older patients using propensity score matching (PSM) analysis to reduce the effect of treatment or patient selection bias.…”