| BACKGROUND With the rapid development of medical technology and the popularization of medical care,in today’s world,human life expectancy is increasing,and with the increase of life expectancy,the aging problem of the population is gradually increasing,the population aging problem also makes the number of the elderly(≥65 years old)hepatocellular carcinoma(HCC)patients gradually increase.Hepatectomy remains the preferred and most beneficial first-line treatment for patients with HCC.However,the prognosis of partial hepatectomy in elderly patients with HCC is unclear.Accurately evaluating the short-term and long-term outcomes of elderly HCC patients undergoing partial HCC resection and analyzing the factors influencing the prognosis of elderly HCC patients can provide reference and guidance for the clinical decision-making of elderly HCC patients,which has important clinical significance.Propensity score matching(PSM)is an effective analysis method to reduce systematic errors and balance the characteristics of the baseline data.This study aims to evaluate the short-term and long-term outcomes of elderly and non-elderly HCC patients by PSM method,demonstrate the effect of older age on liver resection,and obtain the factors influencing the prognosis of elderly HCC patients after liver resection through multivariate analysis.METHODSThe retrospective clinical and follow-up data of 1745 patients undergoing partial liver malignancies between 2008 and 2020,who were screened and excluded according to the established exclusion criteria.After discharge,1331 HCC patients undergoing partial liver resection were enrolled.The patients enrolled were divided according to age,with HCC patients aged 65 years in the elderly group and HCC patients aged <65years as the non-elderly group.And using the PSM method to balance the differences in the baseline features,After undergoing the PSM.To that each two groups with 334 HCC patients.The probability of major morbidity(Clavien-Dindo grade)and tumor-specific survival(CSS).And identify independent factors associated with the occurrence of serious complications CSS by multivariate regression analysis.And using Kaplan-Meier analysis to demonstrate the differences between long-term postoperative survival between both groups.RESULTSAfter discharge,of the 1331 HCC patients included in this study,363(27.27%)were elderly HCC patients and 968(72.73%)were non-elderly HCC patients.After PSM,two groupings with 334 matched samples were obtained each.The analysis showed that in the cohort before and after PSM,the probability of major morbidity in elderly HCC patients was higher than that in non-elderly patients,and elderly HCC patients had higher Perioperative death before PSM.However,there was no significant difference in the Perioperative death rate after PSM.During the follow-up period,the cohort before and after PSM had significantly less tumor recurrence than non-elderly patients(all P<0.050).After PSM,there was no significant difference in mortality between the elderly and non-elderly groups,but in terms of causes of death,there were higher non-tumor-related deaths in the elderly group,and tumor-related deaths were higher in the elderly group,and similar CSS of HCC patients in both groups(P = 0.087).Univariate analysis showed that age was not an independent risk factor for significant major morbidity and poor CSS(all P> 0.050).Multivariate analysis showed that preoperative alpha-AFP(alpha-fetoprotein),Child-Pugh grade,intraoperative blood transfusion,expanded half liver resection and tumor diameter,while preoperative AFP level,cirrhosis,liver function Child-Pugh grade,macrovessel invasion,microvascular invasion(microvascular invasion,MVI),satellite nodules,and tumor diameter were independently and significantly associated with CSS.CONCLUSIONAge itself had no significant effect on the prognosis of elderly patients with HCC after hepatectomy.Hepatectomy can be safely performed in elderly patients after cautious perioperative management. |
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