To compare survival in older (≥65 years) and younger (<65 years) patients with biliary tract cancer (BTC) and to identify the justification of aggressive approach for BTC in the older group.Methods
Comprehensive data of 326 older and 205 younger patients diagnosed with BTC from 2003 to 2011 were reviewed to compare the outcome between the two groups. Differences in survival were also assessed after adjustment and matching by propensity score.Results
There were no significant differences in sex, symptoms/signs, tumor histology, stage, and surgery between the two groups. However, older subjects presented with more comorbidities, poorer performance status, and underwent fewer chemotherapies and radiotherapies (P < 0.05). The survival was compared between the two groups with BTC. After adjustment for baseline characteristics by the propensity score method, survival was still comparable (P = 0.722). When survival was compared between the treatment group (TG) and supportive care group (SCG) in older patients, TG had a longer survival time than SCG (P = 0.001). This result was confirmed by the propensity analysis (including patients operated; P = 0.001, excluding patients operated; P = 0.001). In the multivariate Cox analysis, surgical resection and chemotherapy were significantly associated with longer survival, whereas advanced tumor stage and lower baseline serum albumin level were found to significantly predict poor survival. However, age was not the factor associated with survival of BTC patients (P = 0.243).Conclusions
Older age was not associated with poor survival in BTC. Therefore, an aggressive approach is reasonable for BTC in older patients. Treatment should not be restricted on the basis of age.