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Albertsmeier, Markus; Engel, Andrea; Guba, Markus; Stintzing, Sebastian; Schiergens, Tobias S.; Schubert-Fritschle, Gabriele; Hölzel, Dieter; Werner, Jens; Angele, Martin K.; Engel, Jutta (2017): Synchronous colorectal liver metastases: focus on the elderly. An effectiveness Study from Routine Care. In: Langenbeck's Archives of Surgery, Vol. 402, No. 8: pp. 1223-1232
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PURPOSE The goal of this study was to analyze the use and the effectiveness of both surgery and different chemotherapies in patients with synchronous colorectal liver metastases (CLMs) ≥70~years compared to younger patients. METHODS Survival was analyzed in 456 patients (24.3% ≥70~years) treated for CLM in a single center using Kaplan-Meier estimation of overall survival (OS), calculation of relative survival as estimate for disease-specific survival, and a Cox regression model. RESULTS Complete surgical resections were achieved more often in patients aged <70~years (39.2 vs. 28.1%, P~=~0.056), and young patients more frequently received irinotecan or platin-based chemotherapies (70.3 vs. 41.6%, P~<~0.001). Three-year OS and relative survival of patients ≥70~years were significantly lower compared to younger patients (OS 34.3 vs. 43.5%, P~=~0.0114). In a Cox regression model, complete surgical removal of liver metastases was the most effective treatment (HR 0.313, P~<~0.001) followed by chemotherapy (irinotecan/platin-based: HR 0.371, 5-FU only: HR 0.673, P~<~0.001). Having >5 liver metastases, the presence of extrahepatic metastases, high grading, and a nodal positive primary but not age ≥70~years were associated with an increased risk of death. CONCLUSIONS Our data support radical resection and highly effective chemotherapy in selected elderly patients with CLM.