Surgical intervention is the established standard of care option in patients diagnosed with localized RCC.
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.
OBJECTIVE: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.
METHODS: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). To adjust for inherent differences between treatment types, propensity-based matched analyses were performed. Competing-risks regression analyses for prediction of OCM were assessed according to treatment type. 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.
RESULTS: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, P= 0.048). In subanalyses, no difference was recorded between PN and RN in patients who were aged ≥75 years (HR: 0.83, P= 0.2), with ≥2 baseline comorbidities at diagnosis (HR: 0.83, P= 0.1), or in patients who were aged ≥75 years and who had ≥2 baseline comorbidities (HR: 0.77, P= 0.2).
CONCLUSIONS: Some elderly patients and/or those with multiple comorbidities at diagnosis may not benefit from PN with respect to OCM. After rigorous patient selection, alternative treatment options could be considered.
Written by:
Sun M, Bianchi M, Trinh QD, Hansen J, Abdollah F, Hanna N, Tian Z, Shariat SF, Montorsi F, Perrotte P, Karakiewicz PI. Are you the author?
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Martiniclinic, University of Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.
Reference: BJU Int. 2012 May 22. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11254.x
PubMed Abstract
PMID: 22612472
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