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

Maxine Sun, Marco Bianchi, Quoc Dien Trinh, Jens Hansen, Firas Abdollah, Nawar Hanna, Zhe Tian, Shahrokh F. Shariat, Francesco Montorsi, Paul Perrotte, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)67-73
Number of pages7
JournalBJU International
Volume111
Issue number1
DOIs
Publication statusPublished - Jan 2013

Keywords

  • comorbidities
  • competing-risks
  • elderly
  • localized renal cell carcinoma
  • nephrectomy

ASJC Scopus subject areas

  • Urology

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