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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
Author(s) -
Sun Maxine,
Bianchi Marco,
Trinh QuocDien,
Hansen Jens,
Abdollah Firas,
Hanwar,
Tian Zhe,
Shariat Shahrokh F.,
Montorsi Francesco,
Perrotte Paul,
Karakiewicz Pierre I.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2012.11254.x
Subject(s) - medicine , renal cell carcinoma , nephrectomy , context (archaeology) , hazard ratio , propensity score matching , proportional hazards model , epidemiology , comorbidity , surgery , urology , confidence interval , kidney , paleontology , biology
What's known on the subject? and What does the study add? Surgical intervention is the established standard of care option in patients diagnosed with localized RCC . The study found that better and rigorous selection of surgical candidates should be implemented in the context of localized RCC as some patients may not benefit from surgery.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 T 1 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.