Comparison of partial vs radical nephrectomy with regard to other‐cause mortality in T1 renal cell carcinoma among patients aged ≥75 years with multiple comorbidities. (22nd May 2012)

• Record Type: Journal Article
• Authors: Sun, Maxine; Bianchi, Marco; Trinh, Quoc‐Dien; Hansen, Jens; Abdollah, Firas; Hanna, Nawar; Tian, Zhe; Shariat, Shahrokh F.; Montorsi, Francesco; Perrotte, Paul; Karakiewicz, Pierre I.
• Is Part Of: BJU international. Volume 111:Number 1(2013:Jan.)
• Page Start: 67
• Page End: 73
• Publication Date: 2012-05-22
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11254.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11254-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11254-list-1001" list-type="bullet"> <list-item> <p>Surgical intervention is the established standard of care option in patients diagnosed with localized RCC.</p> </list-item> <list-item> <p>The study found that better and rigorous selection of surgical candidates should be implemented in the context of localized RCC as some patients may not benefit from surgery.</p> </list-item> </list> </p> </sec> <sec id="bju11254-sec-0002" sec-type="section"> <title>Objective</title> <p> <list id="bju11254-list-0001" list-type="bullet"> <list-item> <p>To quantify the effect of partial nephrectomy (PN) vs radical nephrectomy (RN) on other‐cause mortality (OCM) in elderly patients with localized renal cell carcinoma (RCC) and/or multiple comorbidities.</p> </list-item> </list> </p> </sec> <sec id="bju11254-sec-0003" sec-type="section"> <title>Methods</title> <p> <list id="bju11254-list-0002" list-type="bullet"> <list-item> <p>Using the Surveillance, Epidemiology, and End Results Medicare‐linked database, patients with T1 RCC, aged ≥75 years, or who had ≥2 comorbidities, were identified (1988–2005).</p> </list-item> <list-item> <p>To adjust for inherent differences between treatment types, propensity‐based matched analyses were performed.</p> </list-item> <list-item> <p>Competing‐risks regression analyses for prediction of OCM were assessed according to treatment type.</p> </list-item> <list-item> <p>The effect of PN and RN on OCM was examined in three sub‐groups: patients aged ≥75 years; patients with ≥2 comorbidities; and patients aged ≥75 years with ≥2 comorbidities.</p> </list-item> </list> </p> </sec> <sec id="bju11254-sec-0004" sec-type="section"> <title>Results</title> <p> <list id="bju11254-list-0003" list-type="bullet"> <list-item> <p>After propensity‐based matched analyses and adjustment for all covariates, PN was found to exert a protective effect relative to RN with respect to OCM in all patients (hazard ratio [HR]: 0.84, <italic>P</italic> = 0.048).</p> </list-item> <list-item> <p>In subanalyses, no difference was recorded between PN and RN in patients who were aged ≥75 years (HR: 0.83, <italic>P</italic> = 0.2), with ≥2 baseline comorbidities at diagnosis (HR: 0.83, <italic>P</italic> = 0.1), or in patients who were aged ≥75 years and who had ≥2 baseline comorbidities (HR: 0.77, <italic>P</italic> = 0.2).</p> </list-item> </list> </p> </sec> <sec id="bju11254-sec-0005" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11254-list-0004" list-type="bullet"> <list-item> <p>Some elderly patients and/or those with multiple comorbidities at diagnosis may not benefit from PN with respect to OCM.</p> </list-item> <list-item> <p>After rigorous patient selection, alternative treatment options could be considered.</p> </list-item> </list> </p> </sec> </abstract>