1302 COMPARATIVE OUTCOMES OF SURGICAL AND NONSURGICAL MANAGEMENT OF RENAL MASSES IN PATIENTS >75 YEARS OF AGE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (II)1 Apr 20131302 COMPARATIVE OUTCOMES OF SURGICAL AND NONSURGICAL MANAGEMENT OF RENAL MASSES IN PATIENTS >75 YEARS OF AGE Behfar Ehdaie, Nick Hauser, Aaron Bernie, and Paul Russo Behfar EhdaieBehfar Ehdaie New York, NY More articles by this author , Nick HauserNick Hauser New York, NY More articles by this author , Aaron BernieAaron Bernie New York, NY More articles by this author , and Paul RussoPaul Russo New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2656AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) represents an effective management strategy for incidental small renal masses; however the impact of nonsurgical management of larger renal masses is understudied. Specifically, patients >75 years of age with incidental renal masses are at increased risk to die of cardiovascular and other non-cancer comorbid medical conditions. We evaluated cancer-specific and other-cause mortality after either AS or nephrectomy, in patients >75 years of age. METHODS Following IRB approval, we prospectively reviewed an institutional database and identified 703 consecutive patients >75 years of age treated by partial or radical nephrectomy or managed with AS from 1983 to 2012 at Memorial Sloan Kettering Cancer Center. Cox proportional hazards regression was used to assess differences in cancer-specific survival and other-cause mortality between patients treated with nephrectomy and AS adjusting for age, tumor dimensions, and comorbidity. RESULTS Overall, 520 (74%) patients were treated by partial or radical nephrectomy and 183 (26%) patients were managed by AS. Median follow-up among patients alive treated by surgery and patients with AS were 38 months and 24 months, respectively. No patients treated with AS died of kidney cancer. After 5 years, 23 (4.4%) and 71 (13.7%) patients treated with surgery died of kidney cancer and other causes, respectively. In contrast, 12 (7.4%) of AS patients died of other causes at 5 years. After adjustment for factors associated with survival, including Charlson comorbidity score, and tumor size, treatment type was not associated with overall survival (p=0.079, 95% CI 0.28-1.07). CONCLUSIONS In patients >75 years of age, AS does not adversely impact cancer-specific and overall mortality. The increasing burden of comorbid conditions associated with aging represent a competing risk on overall mortality in patients >75 years of age with renal tumors. AS appears to be a legitimate and safe treatment option for small renal mass in patients > 75 years of age and comorbid medical conditions. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e531-e532 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Behfar Ehdaie New York, NY More articles by this author Nick Hauser New York, NY More articles by this author Aaron Bernie New York, NY More articles by this author Paul Russo New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...