Synchronous colorectal liver metastases: focus on the elderly

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) ae<yen>70 years compared to younger patients. Survival was analyzed in 456 patients (24.3% ae<yen>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. 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. Our data support radical resection and highly effective chemotherapy in selected elderly patients with CLM.