Background
Methods
Data collection
Study population
Statistical analysis
Results
Comparison of elderly and younger patients before PS matching
Demographic characteristics and short-term outcomes
Variable | Aged < 70 years (n = 651) | Aged ≥ 70 years (n = 73) | P value | Standardized mean difference |
---|---|---|---|---|
Age (years) | 56 (19–69) | 73 (70–83) | < 0.001 | |
Gender, male | 417 (64.1%) | 51 (69.9%) | 0.325 | 0.173 |
ASA | < 0.001 | 0.487 | ||
I–II | 596 (91.6%) | 48 (65.8%) | ||
III–IV | 55 (8.4%) | 25 (34.2%) | ||
Comorbidity | 274 (42.1%) | 50 (68.5%) | < 0.001 | 0.564 |
Cerebrovascular disease | 17 (2.6%) | 5 (6.8%) | 0.061 | 0.134 |
Arrhythmia | 9 (1.4%) | 1 (1.4%) | 1.000 | <0.001 |
Ischemic heart disease | 36(5.5%) | 9(12.3%) | 0.036 | 0.474 |
Diabetes mellitus | 94 (14.4%) | 15 (20.5%) | 0.166 | 0.265 |
Hypertension | 178 (27.3%) | 40 (54.8%) | < 0.001 | 0.648 |
Chronic obstructive pulmonary disease | 5 (0.8%) | 2 (2.7%) | 0.151 | 0.362 |
Chronic renal dysfunction | 4 (0.6%) | 1 (1.4%) | 0.413 | 0.242 |
Accompanying liver disease | 29 (4.5%) | 2 (2.7%) | 0.760 | 0.198 |
Primary tumor sideness | 0.198 | |||
Right side | 112 (17.2%) | 17 (23.3%) | ||
Left side | 539 (82.8%) | 56 (76.7%) | ||
Primary T | 0.659 | |||
pT1-T2 | 64 (9.8%) | 6 (8.2%) | ||
pT3-T4 | 587 (90.2%) | 67 (91.8%) | ||
Primary N | 0.869 | 0.087 | ||
pN0 | 199 (30.6%) | 23 (31.5%) | ||
pN1-2 | 452 (69.4%) | 50 (68.5%) | ||
Number of liver metastases(LM) | 0.032 | 0.674 | ||
≤ 3 | 447 (68.7%) | 59 (80.8%) | ||
> 3 | 204 (31.3%) | 14 (19.2%) | ||
Distribution of LM | 0.084 | |||
Unilobar | 341 (52.4%) | 46 (63.0%) | ||
Bilobar | 310 (47.6%) | 27 (37.0%) | ||
Maximum diameter of LM | 0.631 | |||
≤ 5 cm | 566 (86.9%) | 62 (84.9%) | ||
> 5 cm | 85 (13.1%) | 11 (15.1%) | ||
Temporal relationship | 0.796 | |||
Synchronous | 367 (56.4%) | 40 (54.8%) | ||
Metachronous | 284 (44.6%) | 33 (45.2%) | ||
Preoperative chemotherpy cycles | 0.025 | 0.743 | ||
≤ 6 cycles | 565 (86.8%) | 70 (95.9%) | ||
> 6 cycles | 86 (13.2%) | 3 (4.1%) | ||
Preoperative clinical risk score (CRS) | 0.590 | 0.234 | ||
0–2 | 344 (52.8%) | 41 (56.2%) | ||
3–5 | 307 (47.2%) | 32 (43.8%) | ||
RAS/BRAF mutation | 215(33.0%) | 27(37.0%) | 0.496 | 0.286 |
Preoperative CEA (ng/ml) | 8.19 (0.47–1351.00) | 8.53 (1.23–224.80) | 0.566 | 0.344 |
Preoperative CA199(U/ml) | 22.03 (0.00–29909.00) | 24.56 (0.00–1354.00) | 0.633 | |
Repeat resection after recurrence | 73 (11.2%) | 8 (11.0%) | 0.948 | 0.063 |
Postoperative chemotherapy | 442 (67.9%) | 40 (54.8%) | 0.024 | 0.766 |
Variable | Aged < 70 years (n = 651) | Aged ≥ 70 years (n = 73) | P value | Standardized mean difference |
---|---|---|---|---|
Combined with RFA | 85 (13.1%) | 3 (4.1%) | 0.027 | 0.486 |
Two-stage hepatectomy | 9 (1.4%) | 1 (1.4%) | 1.000 | |
Simultaneous resection | 120 (18.4%) | 17 (23.3%) | 0.315 | |
Major hepatectomy | 127 (19.5%) | 9 (12.3%) | 1.136 | 0.127 |
Pringle clamp | 513 (78.8%) | 53 (72.6%) | 0.224 | |
Pringle clamp time (min) | 20 (0–98) | 15 (0–60) | 0.061 | |
R1 margin | 96 (14.7%) | 7 (9.6%) | 0.232 | |
Intraoperative blood loss (ml) | 200 (0–6500) | 150 (20–1000) | 0.529 | |
Intraoperative RBC transfusion | 28 (4.3%) | 5 (6.8%) | 0.367 | |
Intraoperative RBC transfused (U) | 4 (1–12) | 3 (2–4) | 0.269 | |
Operation time (min) | 187 (32–600) | 180 (60–330) | 0.146 | |
Hospital stay (days) | 9 (4–78) | 9 (4–48) | 0.909 | |
Postoperative complications | 186 (28.6%) | 20 (27.4%) | 0.833 | |
Clavien-Dindo classification | 0.262 | |||
I–II | 106 (57.0%) | 14 (70.0%) | ||
III–V | 80 (43.0%) | 6 (30.0%) | ||
General complications | 58 (8.9%) | 4 (5.5%) | 0.321 | |
Postoperative heart failure | 2 (0.3%) | 0 (0%) | 1.000 | |
Postoperative coronary artery disease | 6 (0.9%) | 0 (0%) | 1.000 | |
Postoperative arrhythmia | 8 (1.2%) | 1 (1.4%) | 1.000 | |
Postoperative lung infection | 5 (0.8%) | 1 (1.4%) | 0.473 | |
Postoperative renal failure | 2 (0.3%) | 0 (0%) | 1.000 | |
Postoperative pulmonary embolism | 1 (0.2%) | 0 (0%) | 1.000 | |
Postoperative deep vein thrombosis | 2 (0.3%) | 0 (0%) | 1.000 | |
Postoperative urinary infection | 4 (0.6%) | 0 (0%) | 1.000 | |
Postoperative pleural effusion | 28 (4.3%) | 2 (2.7%) | 0.759 | |
Postoperative stress ulcer | 6 (0.9%) | 1 (1.4%) | 0.526 | |
Surgical complications | 129 (19.8%) | 11 (15.1%) | 0.330 | |
Posthepatectomy liver failure | 22 (3.4%) | 2 (2.7%) | 1.000 | |
Postoperative abdominal infection | 53 (8.1%) | 7 (9.6%) | 0.671 | |
Postoperative bile leakage | 37 (5.7%) | 3 (4.1%) | 0.788 | |
Postoperative abdominal collection | 22 (3.4%) | 2 (2.7%) | 1.000 | |
Incision infection | 9 (1.4%) | 0 (0%) | 0.610 | |
Postoperative ileus | 12 (1.8%) | 0 (0%) | 0.622 | |
Postoperative abdominal bleeding | 26 (4.0%) | 1 (1.4%) | 0.508 | |
ICU | 18 (2.8%) | 8 (11.0%) | 0.003 | |
ICU stay (days) | 1 (1–6) | 1.5 (1–6) | 0.927 | |
Postoperative RBC transfusion | 50 (7.7%) | 7 (9.6%) | 0.566 | |
Postoperative RBC transfused (U) | 4 (2–58) | 2 (2–6) | 0.510 | |
Reoperation | 12 (1.8%) | 0 (0%) | 0.622 | |
Readmission | 3 (0.5%) | 3 (4.1%) | 0.016 | |
Mortality (in-hospital) | 1 (0.2%) | 0 (0%) | 1.000 | |
Mortality (90-day) | 1 (0.2%) | 0 (0%) | 1.000 | |
Recurrence | 467 (71.7%) | 49 (67.1%) | 0.409 | |
Intrahepatic recurrence | 355 (54.5%) | 40 (54.8%) | 0.966 | |
Extrahepatic recurrence | 112 (17.2%) | 9 (12.3%) | 0.290 | |
Disease-free survival | 0.374 | |||
1-year | 46.6% | 50.5% | ||
3-year | 26.2% | 31.0% | ||
5-year | 23.5% | 25.5% | ||
Overall survival | 0.219 | |||
1-year | 94.1% | 90.4% | ||
3-year | 60.5% | 56.3% | ||
5-year | 48.7% | 43.6% | ||
Cancer-specific survival | 0.512 | |||
1-year | 94.4% | 90.4% | ||
3-year | 61.1% | 59.0% | ||
5-year | 49.2% | 45.7% |
Long-term outcomes
Comparison of elderly and younger patients after PS matching
Demographic characteristics and short-term outcomes
Variable | Aged < 70 years (n = 128) | Aged ≥ 70 years (n = 64) | P value | Standardized mean difference |
---|---|---|---|---|
Age (years) | 57 (31–69) | 72.5 (70–83) | < 0.001 | |
Gender, male | 73 (57.0%) | 43 (67.2%) | 0.175 | 0.075 |
ASA | 0.200 | 0.083 | ||
I–II | 106 (82.8%) | 48 (75.0%) | ||
III | 22 (17.2%) | 16 (25.0%) | ||
Comorbidity | 65 (50.8%) | 41 (61.1%) | 0.081 | 0.086 |
Cerebrovascular disease | 4 (3.1%) | 2 (3.1%) | 1.000 | < 0.001 |
Arrhythmia | 3 (2.3%) | 1 (1.6%) | 1.000 | < 0.001 |
Ischemic heart disease | 11 (8.6%) | 6 (9.4%) | 0.857 | 0.076 |
Diabetes mellitus | 21 (16.4%) | 12 (18.8%) | 0.685 | 0.089 |
Hypertension | 49 (38.3%) | 31 (48.4%) | 0.178 | 0.077 |
Chronic obstructive pulmonary disease | 0 (0.0%) | 1 (1.6%) | 0.333 | 0.083 |
Chronic renal dysfunction | 0 (0.0%) | 1 (1.6%) | 0.333 | 0.065 |
Accompanying liver disease | 10 (7.8%) | 2 (3.1%) | 0.343 | 0.076 |
Primary tumor sideness | 0.447 | |||
Right side | 24 (18.8%) | 15 (23.4%) | ||
Left side | 104 (81.3%) | 49 (76.6%) | ||
Primary T | 0.557 | |||
pT1-T2 | 8 (6.3%) | 6 (9.4%) | ||
pT3-T4 | 120 (93.8%) | 58 (90.6%) | ||
Primary N | 0.653 | 0.035 | ||
pN0 | 36 (28.1%) | 20 (31.3%) | ||
pN1-2 | 92 (71.9%) | 44 (68.8%) | ||
Number of liver metastases(LM) | 0.433 | 0.056 | ||
≤ 3 | 106 (82.8%) | 50 (78.1%) | ||
> 3 | 22 (17.2%) | 14 (21.9%) | ||
Distribution of LM | 1.000 | |||
Unilobar | 80 (62.5%) | 40 (62.5%) | ||
Bilobar | 48 (37.5%) | 24 (37.5%) | ||
Maximum diameter of LM | 0.509 | |||
≤ 5 cm | 103(80.5%) | 54(84.4%) | ||
> 5 cm | 25(19.5%) | 10(15.6%) | ||
Temporal relationship | 0.126 | |||
Synchronous | 61 (47.7%) | 38 (59.4%) | ||
Metachronous | 67 (52.3%) | 26 (40.6%) | ||
Preoperative chemotherpy cycles | 1.000 | < 0.001 | ||
≤ 6 cycles | 122 (95.3%) | 61 (95.3%) | ||
> 6 cycles | 6 (4.7%) | 3 (4.7%) | ||
Preoperative clinical risk score (CRS) | 0.535 | 0.065 | ||
0–2 | 76 (59.4%) | 35 (54.7%) | ||
3–5 | 52 (40.6%) | 29 (45.3%) | ||
RAS/BRAF mutation | 47 (36.9%) | 22 (34.4%) | 0.750 | 0.046 |
Preoperative CEA (ng/ml) | 9.10 (0.93–794.50) | 9.41 (1.23–224.80) | 0.858 | 0.102 |
Preoperative CA199 (U/ml) | 28.11 (0.00–28,385.00) | 24.06 (0.00–1354.00) | 0.360 | |
Repeat resection after recurrence | 20 (15.6%) | 8 (12.5%) | 0.563 | 0.078 |
Postoperative chemotherapy | 86 (67.2%) | 38 (59.4%) | 0.286 | 0.094 |
Preoperative chemotherapy regimes | 0.063 | |||
Oxaliplatin-based | 37 (28.9%) | 29 (45.3%) | ||
Irinotecan-based | 8 (6.3%) | 5 (7.8%) | ||
5-Fu-based | 1 (0.8%) | 2 (3.1%) | ||
Hepatic artery infusion | 4 (3.1%) | 1 (1.6%) | ||
Postoperative chemotherapy regimes | 0.601 | |||
Oxaliplatin-based | 50 (39.1%) | 28 (43.8%) | ||
Irinotecan-based | 22 (17.2%) | 6 (9.4%) | ||
5-Fu-based | 8 (6.3%) | 3 (4.7%) | ||
Hepatic artery infusion | 1 (0.8%) | 0 (0%) |
Variable | Aged < 70 years (n = 128) | Aged ≥ 70 years (n = 64) | P value | Standardized mean difference |
---|---|---|---|---|
Combined with RFA | 1 (0.8%) | 3 (4.7%) | 0.109 | 0.043 |
Two-stage hepatectomy | 1 (0.8%) | 1 (1.6%) | 1.000 | |
Simultaneous resection | 17 (13.3%) | 16 (25.0%) | 0.066 | |
Major hepatectomy | 24 (18.8%) | 8 (12.5%) | 0.273 | 0.023 |
Pringle clamp | 95 (74.2%) | 44 (68.8%) | 0.424 | |
Pringle clamp time (min) | 15 (0–60) | 15 (0–60) | 0.465 | |
R1 margin | 3 (2.3%) | 6 (9.4%) | 0.062 | |
Intraoperative blood loss (ml) | 200 (20–6500) | 175 (20–800) | 0.046 | |
Intraoperative RBC transfusion | 10 (7.9%) | 3 (4.7%) | 0.549 | |
Intraoperative RBC transfused (U) | 0 (0–8) | 0 (0–4) | 0.313 | |
Operation time (min) | 172.5 (60–570) | 180 (60–327) | 0.799 | |
Hospital stay (days) | 11 (4–70) | 8 (4–48) | 0.020 | |
Postoperative complications | 37 (28.9%) | 17 (26.6%) | 0.733 | |
Clavien-Dindo classification | 0.062 | |||
I–II | 16 (43.2%) | 12 (70.6%) | ||
III–V | 21 (56.8%) | 5 (29.4%) | ||
General complications | 15 (11.7%) | 4 (6.3%) | 0.232 | |
Postoperative heart failure | 0 (0.0%) | 0 (0%) | - | |
Postoperative coronary artery disease | 2 (1.6%) | 0 (0%) | 0.553 | |
Postoperative arrhythmia | 0 (0.0%) | 1 (1.6%) | 0.333 | |
Postoperative lung infection | 1 (0.8%) | 1 (1.6%) | 1.000 | |
Postoperative renal failure | 0 (0.0%) | 0 (0.0%) | - | |
Postoperative pulmonary embolism | 1 (0.8%) | 0 (0.0%) | 1.000 | |
Postoperative deep vein thrombosis | 0 (0.0%) | 0 (0.0%) | - | |
Postoperative urinary infection | 0 (0.0%) | 0 (0.0%) | - | |
Postoperative pleural effusion | 10 (7.8%) | 2 (3.1%) | 0.343 | |
Postoperative stress ulcer | 1 (0.8%) | 1 (1.6%) | 1.000 | |
Surgical complications | 24 (18.8%) | 8 (12.5%) | 0.273 | |
Posthepatectomy liver failure | 2 (1.6%) | 1 (1.6%) | 1.000 | |
Postoperative abdominal infection | 3 (2.3%) | 5 (7.8%) | 0.120 | |
Postoperative bile leakage | 8 (6.3%) | 2 (3.1%) | 0.500 | |
Postoperative abdominal collection | 4 (3.1%) | 2 (3.1%) | 1.000 | |
Incision infection | 3 (2.3%) | 0 (0.0%) | 0.552 | |
Postoperative ileus | 4 (3.1%) | 0 (0.0%) | 0.303 | |
Postoperative abdominal bleeding | 5 (3.9%) | 1 (1.6%) | 0.666 | |
ICU | 5 (3.9%) | 6 (9.4%) | 0.185 | |
ICU stay (days) | 2 (1–6) | 1.5 (1–6) | 0.537 | |
Postoperative RBC transfusion | 11 (8.6%) | 7 (10.9%) | 0.599 | |
Postoperative RBC transfused (U) | 4 (2–58) | 2 (2–6) | 0.151 | |
Reoperation | 4 (3.1%) | 0 (0.0%) | 0.303 | |
Readmission | 0 (0.0%) | 3 (4.7%) | 0.036 | |
Mortality (in-hospital) | 1 (0.8%) | 0 (0.0%) | 1.000 | |
Mortality (90-day) | 1 (0.8%) | 0 (0.0%) | 1.000 | |
Recurrence | 102 (79.7%) | 43 (67.2%) | 0.058 | |
Intrahepatic recurrence | 70 (54.7%) | 34 (53.1%) | 0.838 | |
Extrahepatic recurrence | 32 (25.0%) | 9 (14.1%) | 0.081 | |
Disease-free survival | 0.269 | |||
1-year | 43.5% | 51.4% | ||
3-year | 21.2% | 30.3% | ||
5-year | 18.5% | 24.1% | ||
Overall survival | 0.401 | |||
1-year | 89.0% | 89.1% | ||
3-year | 47.8% | 57.7% | ||
5-year | 32.7% | 45.4% | ||
Cancer-specific survival | 0.163 | |||
1-year | 89.8% | 89.1% | ||
3-year | 48.2% | 61.1% | ||
5-year | 32.9% | 48.0% |
Variable | Relative ratio | 95% Confidence interval | P value |
---|---|---|---|
Disease-free survival | |||
Age (≥ 70 years old) | 0.860 | 0.602–1.230 | 0.409 |
RAS/BRAF mutation | 1.558 | 1.117–2.174 | 0.009 |
Preoperative CEA (≥ 20 ng/ml) | 1.635 | 1.155–2.314 | 0.006 |
Preoperative CRS (≥ 3) | 1.637 | 1.142–2.347 | 0.007 |
Number of Liver metastases (> 3) | 1.732 | 1.120–2.678 | 0.014 |
Overall survival | |||
Age (≥ 70 years old) | 0.828 | 0.550–1.247 | 0.367 |
RAS/BRAF mutation | 1.432 | 0.985–2.081 | 0.060 |
Preoperative CEA (≥ 20 ng/ml) | 1.699 | 1.157–2.497 | 0.007 |
Preoperative CRS (≥ 3) | 1.638 | 1.141–2.352 | 0.007 |
Cancer-specific survival | |||
Age (≥ 70 years old) | 0.699 | 0.455–1.076 | 0.103 |
RAS/BRAF mutation | 1.348 | 0.911–1.994 | 0.136 |
Preoperative CEA (≥ 20 ng/ml) | 2.008 | 1.358–2.968 | < 0.001 |
Preoperative CRS (≥ 3) | 1.548 | 1.069–2.241 | 0.021 |