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 language | English |
|---|---|
| Pages (from-to) | 541-546 |
| Number of pages | 6 |
| Journal | BJU International |
| Volume | 118 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 1 2016 |
Fingerprint
Keywords
- elderly patients
- kidney cancer
- local tumour ablation
- non-surgical management
- observation
- oncological outcomes
ASJC Scopus subject areas
- Medicine(all)
- Urology
Cite this
Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer : a competing risks analysis. / Larcher, Alessandro; Trudeau, Vincent; Sun, Maxine; Boehm, Katharina; Meskawi, Malek; Tian, Zhe; Fossati, Nicola; Dell'Oglio, Paolo; Capitanio, Umberto; Briganti, Alberto; Shariat, Shahrokh F.; Montorsi, Francesco; Karakiewicz, Pierre I.
In: BJU International, Vol. 118, No. 4, 01.10.2016, p. 541-546.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer
T2 - a competing risks analysis
AU - Larcher, Alessandro
AU - Trudeau, Vincent
AU - Sun, Maxine
AU - Boehm, Katharina
AU - Meskawi, Malek
AU - Tian, Zhe
AU - Fossati, Nicola
AU - Dell'Oglio, Paolo
AU - Capitanio, Umberto
AU - Briganti, Alberto
AU - Shariat, Shahrokh F.
AU - Montorsi, Francesco
AU - Karakiewicz, Pierre I.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - elderly patients
KW - kidney cancer
KW - local tumour ablation
KW - non-surgical management
KW - observation
KW - oncological outcomes
UR - http://www.scopus.com/inward/record.url?scp=84987619544&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84987619544&partnerID=8YFLogxK
U2 - 10.1111/bju.13326
DO - 10.1111/bju.13326
M3 - Article
C2 - 26384713
AN - SCOPUS:84987619544
VL - 118
SP - 541
EP - 546
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - 4
ER -