title: Effect of age on survival in patients undergoing resection of hepatocellular carcinoma.
abstract: BACKGROUND
  The benefit of surgical intervention for cancer should be estimated in relation to the life expectancy of the general population. The aim of this study was to provide a measure of relative survival after hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Consecutive patients with liver cirrhosis and HCC who underwent hepatectomy were divided into age quartiles for analysis. Short- and mid-term survival rates were used to estimate survival until death for all patients, in relation to age and other co-variables. Years of life lost (YLL) were estimated using a reference cohort, derived from the general population matched for sex, age and year of diagnosis.
  
  
  RESULTS
  Some 919 patients were included in the study. The following age quartiles were identified: less than 60 years (229 patients), 60-66 years (230), 67-70 years (231) and over 70 years (229). Postoperative mortality rates were similar between age quartiles, as were survival rates up to 3 years (P = 0·404). A statistically significant reduction in 5-10-year survival rates was observed with ageing (P = 0·001). Relative survival calculation showed that the youngest age quartile (less than 60 years) experienced the longest entire postoperative lifespan (15·6 years) but also the greatest number of YLL (11·0 years). Patients aged over 70 years had the shortest entire postoperative lifespan (6·4 years) but also the smallest number of YLL (3·7 years).
  
  
  CONCLUSIONS
  Although survival after liver resection for HCC is shortest in elderly patients, relative survival estimates suggest that hepatectomy can be of benefit in these patients, with a small loss of the entire individual lifespan.
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sposito
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Citterio
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Flores
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Mazzaferro
mesh_terms: D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome