Long-term and short-term outcomes of curative-intent resection for elderly and younger patients with gallbladder carcinoma: a multicentre propensity score-matched cohort study.

Abstract

Background: While curative-intent resection for gallbladder cancer (GBC) is being increasingly performed in elderly patients, perioperative morbidity and long-term oncological outcomes in this population remain unclear.

Methods: Consecutive patients with GBC who underwent curative-intent resection (2016-2020) were identified from a multicentre database and stratified as elderly (>70 years) or younger (≤70 years). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimise selection bias. The outcomes compared included overall survival (OS), cancer-specific survival (CSS) and short-term outcomes. Logistic regression was used to identify risk factors for major morbidity and Cox regression was used for CSS, with the Fine-Gray competing risk model further applied to account for non-cancer-related death in the analysis of CSS.

Results: Among the 575 patients enrolled, 432 were younger and 143 were elderly. After 1:1 PSM and IPTW, elderly patients had significantly higher 90-day major morbidity rates than younger patients (p=0.029 and p=0.010, respectively), but also demonstrated better CSS in both cohorts (p=0.038 and p<0.001, respectively). OS was significantly longer in elderly patients only after PSM (p<0.001), with no significant difference after IPTW (p=0.684). Multi-adjusted analysis confirmed that advanced age was an independent risk factor for major morbidities (original cohort: OR 1.71 (95% CI 1.12 to 2.59); PSM: OR 1.88 (95% CI 1.08 to 3.30); IPTW: OR 1.83 (95% CI 1.17 to 2.82)) but was associated with longer CSS (original cohort: HR 0.65 (95% CI 0.44 to 0.97); PSM: HR 0.29 (95% CI 0.18 to 0.45); IPTW: HR 0.62 (95% CI 0.42 to 0.90); Fine-Gray model: HR 0.34 (95% CI 0.30 to 0.39)).

Conclusion: Despite a higher risk of major postoperative morbidity, advanced age itself might not be considered a contraindication for curative-intent resection. Selected elderly patients with GBC may achieve superior CSS compared to their younger counterparts.