title: Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study.
abstract: BACKGROUND
  Because many physicians seem reluctant to recommend splenectomy for elderly patients with immune thrombocytopenia (ITP), we investigated the safety and efficacy of splenectomy and the predictive factors for response in these patients.
  
  
  METHODS
  184 patients with primary ITP were retrospectively analyzed based on age at splenectomy: an elderly group (≥60 years, n = 52) and a younger group (<60 years, n = 132).
  
  
  RESULTS
  There was no difference in the response rate of elderly versus younger patients (80.7 vs. 80.3%, p = 0.466). Relapse (45.2 vs. 22.6%, p = 0.006), complications, and median postoperative stay (9.5 vs. 7 days, p = 0.019) were significantly higher in the elderly group. The 5-year relapse-free survival of responders was 51.8% in the elderly group and 76.3% in the younger group (p = 0.002). Response to any treatment before splenectomy (HR 2.9, 95% CI: 1.24-6.80, p = 0.014) and platelet count on postoperative day 14 ≥200 × 109/l (HR 31.43, 95% CI: 4.15-238.28, p = 0.001) were independent factors for a favorable response.
  
  
  CONCLUSIONS
  Age ≥60 years did not influence the response to splenectomy but was associated with increased relapse and postoperative complications. Splenectomy could provide a durable long-term response for elderly ITP patients.
authors.affiliation: Department of Internal Medicine at Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Park
authors.forename: Hyeon Gyu
authors.initials: HG
authors.lastname: Yi
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Kim
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.forename: Jinny
authors.initials: J
authors.lastname: Park
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Zang
authors.forename: Se Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Seong Kyu
authors.initials: SK
authors.lastname: Park
authors.forename: Dae Sik
authors.initials: DS
authors.lastname: Hong
authors.forename: Guk Jin
authors.initials: GJ
authors.lastname: Lee
authors.forename: Jong-Youl
authors.initials: JY
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult