Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis

Alessandro Larcher, Vincent Trudeau, Maxine Sun, Katharina Boehm, Malek Meskawi, Zhe Tian, Nicola Fossati, Paolo Dell'Oglio, Umberto Capitanio, Alberto Briganti, Shahrokh F. Shariat, Francesco Montorsi, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Objectives: To examine, using competing risks regression, differences in cancer-specific mortality (CSM) that might distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer. Patients and Methods: The study focused on 1 860 patients with cT1a kidney cancer treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results-Medicare database. Propensity-score matching was used. The study outcome was CSM. Multivariable competing risks regression analyses, adjusting for other-cause mortality as well as patient (including comorbidities) and tumour characteristics, were fitted. Results: Overall, fewer patients underwent LTA than OBS (30 vs 70%; n = 553 vs n = 1 307). Compared with patients in the OBS group, those in the LTA group were younger (median age 77 vs 78 years; P < 0.001), more likely to be white (84 vs 78%; P = 0.005), more frequently married (59 vs 52%; P = 0.02) and more frequently of high socio-economic status (54 vs 45%; P = 0.001). After propensity-score matching, 553 patients who underwent LTA and 553 who underwent OBS remained for subsequent analyses. The mean standardized differences of patient characteristics between the two groups were <10%, indicating a high degree of similarity. After LTA or OBS, the 5-year CSM estimates from Poisson regression-derived smoothed plots were 3.5 and 9.1%, respectively. In multivariable competing risks regression analyses, LTA use was found to have a protective effect on CSM (hazard ratio 0.47 [95% confidence interval 0.25–0.89]; P = 0.02). Conclusions: After adjustment for comorbidity and tumour characteristics in elderly patients with kidney cancer, LTA was associated with a clinically and statistically significant protective effect on CSM, compared with OBS. This advantage of LTA deserves consideration when obtaining informed consent.

Original languageEnglish
Pages (from-to)541-546
Number of pages6
JournalBJU International
Volume118
Issue number4
DOIs
Publication statusPublished - Oct 1 2016

Keywords

  • elderly patients
  • kidney cancer
  • local tumour ablation
  • non-surgical management
  • observation
  • oncological outcomes

ASJC Scopus subject areas

  • Medicine(all)
  • Urology

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    Larcher, A., Trudeau, V., Sun, M., Boehm, K., Meskawi, M., Tian, Z., Fossati, N., Dell'Oglio, P., Capitanio, U., Briganti, A., Shariat, S. F., Montorsi, F., & Karakiewicz, P. I. (2016). Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis. BJU International, 118(4), 541-546. https://doi.org/10.1111/bju.13326