Partial versus radical nephrectomy in very elderly patients

a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

Maria C. Mir, Nicola Pavan, Umberto Capitanio, Alessandro Antonelli, Ithaar Derweesh, Oscar Rodriguez-Faba, Estefania Linares, Toshio Takagi, Koon H. Rha, Christian Fiori, Tobias Maurer, Chao Zang, Alexandre Mottrie, Paolo Umari, Jean Alexandre Long, Gaelle Fiard, Cosimo De Nunzio, Andrea Tubaro, Andrew T. Tracey, Matteo Ferro & 33 others Ottavio De Cobelli, Salvatore Micali, Luigi Bevilacqua, João Torres, Luigi Schips, Roberto Castellucci, Ryan Dobbs, Giuseppe Quarto, Pierluigi Bove, Antonio Celia, Bernardino De Concilio, Carlo Trombetta, Tommaso Silvestri, Alessandro Larcher, Francesco Montorsi, Carlotta Palumbo, Maria Furlan, Ahmet Bindayi, Zachary Hamilton, Alberto Breda, Joan Palou, Alfredo Aguilera, Kazunari Tanabe, Ali Raheem, Thomas Amiel, Bo Yang, Estevão Lima, Simone Crivellaro, Sisto Perdona, Caterina Gregorio, Giulia Barbati, Francesco Porpiglia, Riccardo Autorino

Research output: Contribution to journalArticle

Abstract

Purpose: To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor. Patients and methods: A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM). Results: A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis. Conclusions: Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.

Original languageEnglish
JournalWorld Journal of Urology
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Propensity Score
Nephrectomy
Mortality
Kidney
Neoplasms
Logistic Models
Databases
Proportional Hazards Models
Survival

Keywords

  • Elderly
  • Kidney cancer
  • Nephrectomy
  • Partial nephrectomy

ASJC Scopus subject areas

  • Urology

Cite this

Partial versus radical nephrectomy in very elderly patients : a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project). / Mir, Maria C.; Pavan, Nicola; Capitanio, Umberto; Antonelli, Alessandro; Derweesh, Ithaar; Rodriguez-Faba, Oscar; Linares, Estefania; Takagi, Toshio; Rha, Koon H.; Fiori, Christian; Maurer, Tobias; Zang, Chao; Mottrie, Alexandre; Umari, Paolo; Long, Jean Alexandre; Fiard, Gaelle; De Nunzio, Cosimo; Tubaro, Andrea; Tracey, Andrew T.; Ferro, Matteo; De Cobelli, Ottavio; Micali, Salvatore; Bevilacqua, Luigi; Torres, João; Schips, Luigi; Castellucci, Roberto; Dobbs, Ryan; Quarto, Giuseppe; Bove, Pierluigi; Celia, Antonio; De Concilio, Bernardino; Trombetta, Carlo; Silvestri, Tommaso; Larcher, Alessandro; Montorsi, Francesco; Palumbo, Carlotta; Furlan, Maria; Bindayi, Ahmet; Hamilton, Zachary; Breda, Alberto; Palou, Joan; Aguilera, Alfredo; Tanabe, Kazunari; Raheem, Ali; Amiel, Thomas; Yang, Bo; Lima, Estevão; Crivellaro, Simone; Perdona, Sisto; Gregorio, Caterina; Barbati, Giulia; Porpiglia, Francesco; Autorino, Riccardo.

In: World Journal of Urology, 01.01.2019.

Research output: Contribution to journalArticle

Mir, MC, Pavan, N, Capitanio, U, Antonelli, A, Derweesh, I, Rodriguez-Faba, O, Linares, E, Takagi, T, Rha, KH, Fiori, C, Maurer, T, Zang, C, Mottrie, A, Umari, P, Long, JA, Fiard, G, De Nunzio, C, Tubaro, A, Tracey, AT, Ferro, M, De Cobelli, O, Micali, S, Bevilacqua, L, Torres, J, Schips, L, Castellucci, R, Dobbs, R, Quarto, G, Bove, P, Celia, A, De Concilio, B, Trombetta, C, Silvestri, T, Larcher, A, Montorsi, F, Palumbo, C, Furlan, M, Bindayi, A, Hamilton, Z, Breda, A, Palou, J, Aguilera, A, Tanabe, K, Raheem, A, Amiel, T, Yang, B, Lima, E, Crivellaro, S, Perdona, S, Gregorio, C, Barbati, G, Porpiglia, F & Autorino, R 2019, 'Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)', World Journal of Urology. https://doi.org/10.1007/s00345-019-02665-2
Mir, Maria C. ; Pavan, Nicola ; Capitanio, Umberto ; Antonelli, Alessandro ; Derweesh, Ithaar ; Rodriguez-Faba, Oscar ; Linares, Estefania ; Takagi, Toshio ; Rha, Koon H. ; Fiori, Christian ; Maurer, Tobias ; Zang, Chao ; Mottrie, Alexandre ; Umari, Paolo ; Long, Jean Alexandre ; Fiard, Gaelle ; De Nunzio, Cosimo ; Tubaro, Andrea ; Tracey, Andrew T. ; Ferro, Matteo ; De Cobelli, Ottavio ; Micali, Salvatore ; Bevilacqua, Luigi ; Torres, João ; Schips, Luigi ; Castellucci, Roberto ; Dobbs, Ryan ; Quarto, Giuseppe ; Bove, Pierluigi ; Celia, Antonio ; De Concilio, Bernardino ; Trombetta, Carlo ; Silvestri, Tommaso ; Larcher, Alessandro ; Montorsi, Francesco ; Palumbo, Carlotta ; Furlan, Maria ; Bindayi, Ahmet ; Hamilton, Zachary ; Breda, Alberto ; Palou, Joan ; Aguilera, Alfredo ; Tanabe, Kazunari ; Raheem, Ali ; Amiel, Thomas ; Yang, Bo ; Lima, Estevão ; Crivellaro, Simone ; Perdona, Sisto ; Gregorio, Caterina ; Barbati, Giulia ; Porpiglia, Francesco ; Autorino, Riccardo. / Partial versus radical nephrectomy in very elderly patients : a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project). In: World Journal of Urology. 2019.
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abstract = "Purpose: To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor. Patients and methods: A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM). Results: A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33{\%} vs 25{\%}; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39{\%} vs 17{\%}; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis. Conclusions: Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.",
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TY - JOUR

T1 - Partial versus radical nephrectomy in very elderly patients

T2 - a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

AU - Mir, Maria C.

AU - Pavan, Nicola

AU - Capitanio, Umberto

AU - Antonelli, Alessandro

AU - Derweesh, Ithaar

AU - Rodriguez-Faba, Oscar

AU - Linares, Estefania

AU - Takagi, Toshio

AU - Rha, Koon H.

AU - Fiori, Christian

AU - Maurer, Tobias

AU - Zang, Chao

AU - Mottrie, Alexandre

AU - Umari, Paolo

AU - Long, Jean Alexandre

AU - Fiard, Gaelle

AU - De Nunzio, Cosimo

AU - Tubaro, Andrea

AU - Tracey, Andrew T.

AU - Ferro, Matteo

AU - De Cobelli, Ottavio

AU - Micali, Salvatore

AU - Bevilacqua, Luigi

AU - Torres, João

AU - Schips, Luigi

AU - Castellucci, Roberto

AU - Dobbs, Ryan

AU - Quarto, Giuseppe

AU - Bove, Pierluigi

AU - Celia, Antonio

AU - De Concilio, Bernardino

AU - Trombetta, Carlo

AU - Silvestri, Tommaso

AU - Larcher, Alessandro

AU - Montorsi, Francesco

AU - Palumbo, Carlotta

AU - Furlan, Maria

AU - Bindayi, Ahmet

AU - Hamilton, Zachary

AU - Breda, Alberto

AU - Palou, Joan

AU - Aguilera, Alfredo

AU - Tanabe, Kazunari

AU - Raheem, Ali

AU - Amiel, Thomas

AU - Yang, Bo

AU - Lima, Estevão

AU - Crivellaro, Simone

AU - Perdona, Sisto

AU - Gregorio, Caterina

AU - Barbati, Giulia

AU - Porpiglia, Francesco

AU - Autorino, Riccardo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor. Patients and methods: A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM). Results: A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis. Conclusions: Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.

AB - Purpose: To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor. Patients and methods: A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM). Results: A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis. Conclusions: Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.

KW - Elderly

KW - Kidney cancer

KW - Nephrectomy

KW - Partial nephrectomy

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U2 - 10.1007/s00345-019-02665-2

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JO - World Journal of Urology

JF - World Journal of Urology

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