OBJECTIVE: To assess modification of comparative cancer survival by cardiovascular (CV) risk and treatment strategy among older patients with small renal masses.
PATIENTS AND METHODS: Patients with localized T1a renal cell carcinoma were identified in the Surveillance, Epidemiology and End Results-Medicare database (1995-2007). Patients were stratified by CV risk, using major atherosclerotic CV comorbidities identified by the Framingham Heart Study, to compare overall (OS), cancer-specific (CSS), and cardiovascular-specific survival (CVSS) for those who deferred therapy (DT) to those undergoing either partial (PN) or radical nephrectomy (RN). Cox proportional hazards and Fine and Gray competing risks regression adjusted for demographics, comorbidities, and tumor size.
RESULTS: A total of 754 (10.5%) patients deferred therapy, 1849 (25.8%) patients underwent PN, and 4574 (63.7%) patients underwent RN. Patients at high CV risk who deferred therapy experienced the greatest CV-to-cancer mortality rate ratio (2.89), and CV risk was generally associated with worse OS and CVSS. Patients in the high CV risk strata had no difference in CSS between treatment strategies (DT vs. PN: HR 0.59 (95%CI 0.25-1.41); DT vs. RN: HR 0.81 (95%CI 0.46-1.43)) while there was a 2-4 fold CSS benefit for surgery in the low CV risk strata.
CONCLUSIONS: Cancer survival was comparable across treatment strategies for older patients with small renal masses at high risk CV disease. Greater attention to CV comorbidity as it relates to competing risks of death and life expectancy may be deserved in selecting patients appropriate for active surveillance because patients at low CV risk might benefit from surgery.
Written by:
Patel HD, Kates M, Pierorazio PM, Allaf ME. Are you the author?
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore; Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore; Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore.
Reference: BJU Int. 2014 Mar 3. Epub ahead of print.
doi: 10.1111/bju.12719
PubMed Abstract
PMID: 24589376
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