You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131651 CARDIOVASCULAR COMORBIDITY AND SURVIVAL AMONG MEDICARE BENEFICIARIES UNDERGOING TREATMENT FOR A SMALL RENAL MASSES Max Kates, Phillip Pierorazio, Hiten Patel, Michael Gorin, Gautam Jayram, and Mohamad Allaf Max KatesMax Kates Baltimore, MD More articles by this author , Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , Hiten PatelHiten Patel Baltimore, MD More articles by this author , Michael GorinMichael Gorin Baltimore, MD More articles by this author , Gautam JayramGautam Jayram Baltimore, MD More articles by this author , and Mohamad AllafMohamad Allaf Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3117AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Older patients with small renal masses (SRM) often have multiple renal and cardiovascular (CV) comorbidities that, regardless of their cancer control, impact their overall survival. We used a large cohort of Medicare beneficiaries to test whether preoperative comorbidity and CV risk effect the operative management and subsequent cause-specific survival in patients undergoing treatment for small renal masses. METHODS From a SEER-Medicare linked database, we selected patients diagnosed between 1995 and 2007 with a SRM) ≤4cm who underwent operative management with a partial nephrectomy (PN), a radical nephrectomy (RN), or non-immediate intervention (NSM, no surgery within 6 months of diagnosis). Propensity scores were calculated based on the likelihood of being placed into the NSM group, and used as controls in cox-proportional hazards model. Patients with at least one cardiovascular comorbidity were considered high CV risk, and separate subgroup survival analyses were performed in this subset. RESULTS Of the 7,177 with SRMs, 754 patients (10.5%) did not undergo surgery, 1849 (26%) underwent PN, and 64% underwent radical nephrectomy. Median follow up times were 40 months (NSM), 46 months (PN) and 62 months (RN) respectively. Overall 5 year survival was 57% for NSM versus 89% (PN) and 80% (RN). Among patients with cardiovascular preoperative risk factors, 5 year overall survival was 48% (NSM) vs 79% (PN) and 60% (RN). In multivariate cox-proportional hazards models controlling for propensity scores, NSM continued to have inferior overall survival compared to patients receiving PN (HR 0.22: 95% Confidence Interval (CI) 0.19-0.24) and RN (HR: 0.37; 95% CI 0.33-0.40). In a subgroup analysis of patients with high CV risk, the NSM group had worse cancer specific, overall, and CV survival compared with the operative groups. In this propensity matched high risk cardiac group, PN was associated with improved overall (HR 0.54; 95% CI 0.44-0.66), cancer specific (HR: 0.33; 95% CI 0.14-0.78), and CV survival(HR: 0.51; 95% CI 0.37-0.68) compared to RN. CONCLUSIONS Among Medicare beneficiaries with a SRM and at least 1 CV risk factor, the overall 5 year survival is 48-79% depending on the treatment group. It appears that sicker patients (at increased preoperative cardiac risk) are receiving RN more often than PN and are thus dying of CV diseases more often. This selection bias may explain persistently worse overall survival among those receiving RN in prior retrospective analyses. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e679 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Kates Baltimore, MD More articles by this author Phillip Pierorazio Baltimore, MD More articles by this author Hiten Patel Baltimore, MD More articles by this author Michael Gorin Baltimore, MD More articles by this author Gautam Jayram Baltimore, MD More articles by this author Mohamad Allaf Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...