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Keywords:

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

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 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.