The Short- and Long-term Outcomes in Elderly Patients with Hepatocellular Carcinoma After Curative Surgery -A Case-controlled Study with Propensity Score Matching

Abstract

Introduction: The incidence of hepatocellular carcinoma (HCC) has been rising due to an increased life expectancy. Although several studies have examined about the outcomes in elderly patients undergoing hepatectomy for HCC, selection bias still remains in the retrospective analyses. The aim of the present study was to clarify the short- and long-term outcomes of surgical treatment in elderly patients (> 75 years) using propensity score matching. Methods: The present study included 420 patients who underwent hepatectomy as their initial treatment with curative intent. Those patients were divided into elderly (n=111) and the non-elderly (n=309) groups. Propensity score matching was performed to minimize the preoperative effect of potential confounders (the statuses of hepatitis B virus antigen and liver damage and the values of prothrombin time and alanine aminotransferase). In the present study, complications were classified into six grades according to the modified Clavien classification. Results: Before matching, the rate of deaths caused by other diseases in the elderly group was significantly higher than that in the non-elderly group (P = 0.004). Although there were no mortality cases in the elderly group, the morbidity rate (Claivien grade 3 or more) in the elderly group was significantly higher than in the non-elderly group (P = 0.010). The overall survival in the elderly patients was poorly than in non-elderly patients despite of marginal difference (P = 0.056). After matching, 89 patients from each group were matched. The preoperative confounding factors were balanced between the two groups. No significant differences were detected in the recurrence-free or overall survivals between the two groups. However, the rates of morbidity (Clavien grade 3 or more) and death due to other diseases in the elderly group were still significantly higher than in the non-elderly group (P = 0.031 and P = 0.016, respectively). The rate of other cancers and pneumonia as death causes tended to be higher in the elderly group than in the non-elderly group. Conclusion: When assessing the usefulness of treatment for the elderly patients, life expectancy and existing comorbidities should be considered. Several studies considering the confounder-adjusted and time dependent effect of age and comorbidities have shown that hepatectomy in the elderly can be justifi ed and provide a survival benefit at a reasonable cost. The present study showed that hepatectomy for HCC in elderly patients is justified.