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BJU Int. 2013 Jan;111(1):67-73. doi: 10.1111/j.1464-410X.2012.11254.x. Epub 2012 May 22.

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.

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  • 1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada. mcw.sun@umontreal.ca

Abstract

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.

© 2012 BJU International.

PMID:
22612472
[PubMed - indexed for MEDLINE]
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