1107 DOES PARTIAL NEPHRECTOMY RESULT IN A DURABLE OVERALL SURVIVAL BENEFIT IN THE ELDERLY?

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121107 DOES PARTIAL NEPHRECTOMY RESULT IN A DURABLE OVERALL SURVIVAL BENEFIT IN THE ELDERLY? Marc Smaldone, Brian Egleston, Anthony Corcoran, Serge Ginzberg, Rosalia Viterbo, David Chen, Richard Greenberg, Robert Uzzo, and Alexander Kutikov Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Brian EglestonBrian Egleston Philadelphia, PA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Serge GinzbergSerge Ginzberg Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author , and Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1215AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent evidence from the EORTC suggests that nephron sparing surgery may not afford an overall survival benefit in all-comers with small localized renal tumors and a normal contralateral kidney. Our objective was to assess if the impact of partial nephrectomy (PN) and radical nephrectomy (RN) on overall mortality differed by patient age in a Medicare population undergoing surgery for T1a Renal Cell Carcinoma (RCC). METHODS Using linked Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified patients >66 years of age who underwent PN or RN for T1a (≤4cm) RCC from 1995-2007. Linked Medicare data were available through 2009. The effects of procedure type on overall mortality by age were assessed using time dependent Cox proportional hazards models adjusted by propensity score based weighting. RESULTS 6,331 patients (mean age 74.2±5.5 years, 56.4% male) who underwent PN (n=1,862; 29.4%) or RN (n=4,469; 70.6%) for ≤4cm RCC (mean tumor size 2.8±0.8cm) were identified. Stratified by procedure type, significant differences were observed in tumor size (p<0.001), gender (p<0.001), marriage status (p=0.01), and area of residence (p=0.003), while Charlson Comorbidity Index (CCI), race, and tumor grade were similar between groups. Adjusting for clinical and demographic characteristics, in patients ≤84 years of age at diagnosis a statistically significant survival benefit for PN compared to RN was observed at one (age 66: HR 2.1 CI 1.2-3.7; age 75: HR 1.4 CI 1.1-1.8) and three (age 66: HR 1.8, CI 1.1-3.0; age 75: HR 1.3 CI 1.1-1.6) years following diagnosis while these trends become insignificant in patients >84 years of age. However, this benefit diminished over time, and little significant survival benefit with PN was observed at 5 and 10 years following surgery regardless of age (>66 years). CONCLUSIONS These data demonstrate that PN is associated with an initial overall survival advantage in Medicare patients with T1a RCC. Nonetheless, the effect diminishes over time and is not generally evident in patients alive at 5 and 10 years following surgery. Lacking strong evidence regarding a long term survival benefit, the decision to perform PN in elderly patients should be individualized and placed in the context of baseline renal function, expected surgical morbidity, and competing risks to survival. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e449 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Smaldone Philadelphia, PA More articles by this author Brian Egleston Philadelphia, PA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Serge Ginzberg Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...