Skip to main content
Erschienen in: World Journal of Urology 1/2020

01.04.2019 | Original Article

Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

verfasst von: Maria C. Mir, Nicola Pavan, Umberto Capitanio, Alessandro Antonelli, Ithaar Derweesh, Oscar Rodriguez-Faba, Estefania Linares, Toshio Takagi, Koon H. Rha, Christian Fiori, Tobias Maurer, Chao Zang, Alexandre Mottrie, Paolo Umari, Jean-Alexandre Long, Gaelle Fiard, Cosimo De Nunzio, Andrea Tubaro, Andrew T. Tracey, Matteo Ferro, Ottavio De Cobelli, Salvatore Micali, Luigi Bevilacqua, João Torres, Luigi Schips, Roberto Castellucci, Ryan Dobbs, Giuseppe Quarto, Pierluigi Bove, Antonio Celia, Bernardino De Concilio, Carlo Trombetta, Tommaso Silvestri, Alessandro Larcher, Francesco Montorsi, Carlotta Palumbo, Maria Furlan, Ahmet Bindayi, Zachary Hamilton, Alberto Breda, Joan Palou, Alfredo Aguilera, Kazunari Tanabe, Ali Raheem, Thomas Amiel, Bo Yang, Estevão Lima, Simone Crivellaro, Sisto Perdona, Caterina Gregorio, Giulia Barbati, Francesco Porpiglia, Riccardo Autorino

Erschienen in: World Journal of Urology | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.

Patients and methods

A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).

Results

A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis.

Conclusions

Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.
Literatur
1.
Zurück zum Zitat Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA Guideline. J Urol 198(3):520–529CrossRef Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA Guideline. J Urol 198(3):520–529CrossRef
2.
Zurück zum Zitat Van Poppel H, Da Pozzo L, Albrecht W et al (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59(4):543–552CrossRef Van Poppel H, Da Pozzo L, Albrecht W et al (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59(4):543–552CrossRef
3.
Zurück zum Zitat Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR (2008) Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 113(1):78–83CrossRef Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR (2008) Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 113(1):78–83CrossRef
5.
Zurück zum Zitat Levey AS, Stevens LA (2010) Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 55(4):622–627CrossRef Levey AS, Stevens LA (2010) Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 55(4):622–627CrossRef
6.
Zurück zum Zitat Sekhon J (2011) Multivariate and propensity score matching. J Stat Softw 42(7):52CrossRef Sekhon J (2011) Multivariate and propensity score matching. J Stat Softw 42(7):52CrossRef
7.
Zurück zum Zitat Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81(3):515–526CrossRef Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81(3):515–526CrossRef
8.
Zurück zum Zitat Kim SP, Gross CP, Meropol N et al (2017) National treatment trends among older patients with T1-localized renal cell carcinoma. Urol Oncol 35(3):113.e15–113.e21CrossRef Kim SP, Gross CP, Meropol N et al (2017) National treatment trends among older patients with T1-localized renal cell carcinoma. Urol Oncol 35(3):113.e15–113.e21CrossRef
9.
Zurück zum Zitat Sun M, Becker A, Tian Z et al (2014) Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol 65(1):235–241CrossRef Sun M, Becker A, Tian Z et al (2014) Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol 65(1):235–241CrossRef
10.
Zurück zum Zitat Patel HD, Kates M, Pierorazio PM et al (2014) Survival after diagnosis of localized T1a kidney cancer: current population-based practice of surgery and nonsurgical management. Urology 83(1):126–132CrossRef Patel HD, Kates M, Pierorazio PM et al (2014) Survival after diagnosis of localized T1a kidney cancer: current population-based practice of surgery and nonsurgical management. Urology 83(1):126–132CrossRef
11.
Zurück zum Zitat Tan H-J, Daskivich TJ, Shirk JD, Filson CP, Litwin MS, Hu JC (2017) Health status and use of partial nephrectomy in older adults with early-stage kidney cancer. Urol Oncol 35(4):153.e7–153.e14CrossRef Tan H-J, Daskivich TJ, Shirk JD, Filson CP, Litwin MS, Hu JC (2017) Health status and use of partial nephrectomy in older adults with early-stage kidney cancer. Urol Oncol 35(4):153.e7–153.e14CrossRef
12.
Zurück zum Zitat Lane BR, Abouassaly R, Gao T et al (2010) Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 116(13):3119–3126CrossRef Lane BR, Abouassaly R, Gao T et al (2010) Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 116(13):3119–3126CrossRef
13.
Zurück zum Zitat Mashni JW, Assel M, Maschino A et al (2015) New chronic kidney disease and overall survival after nephrectomy for small renal cortical tumors. Urology 86(6):1137–1143CrossRef Mashni JW, Assel M, Maschino A et al (2015) New chronic kidney disease and overall survival after nephrectomy for small renal cortical tumors. Urology 86(6):1137–1143CrossRef
14.
Zurück zum Zitat Chung JS, Son NH, Lee SE et al (2015) Overall survival and renal function after partial and radical nephrectomy among older patients with localised renal cell carcinoma: a propensity-matched multicentre study. Eur J Cancer 51(4):489–497CrossRef Chung JS, Son NH, Lee SE et al (2015) Overall survival and renal function after partial and radical nephrectomy among older patients with localised renal cell carcinoma: a propensity-matched multicentre study. Eur J Cancer 51(4):489–497CrossRef
15.
Zurück zum Zitat Smaldone MC, Egleston B, Uzzo RG, Kutikov A (2012) Does partial nephrectomy result in a durable overall survival benefit in the medicare population? J Urol 188(6):2089–2094CrossRef Smaldone MC, Egleston B, Uzzo RG, Kutikov A (2012) Does partial nephrectomy result in a durable overall survival benefit in the medicare population? J Urol 188(6):2089–2094CrossRef
16.
Zurück zum Zitat Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H (2014) Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol 65(2):372–377CrossRef Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H (2014) Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol 65(2):372–377CrossRef
17.
Zurück zum Zitat Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305CrossRef Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305CrossRef
18.
Zurück zum Zitat Huang WC, Elkin EB, Levey AS, Jang TL, Russo P (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors-is there a difference in mortality and cardiovascular outcomes? J Urol 181(1):55–62CrossRef Huang WC, Elkin EB, Levey AS, Jang TL, Russo P (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors-is there a difference in mortality and cardiovascular outcomes? J Urol 181(1):55–62CrossRef
19.
Zurück zum Zitat Capitanio U, Terrone C, Antonelli A et al (2015) Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. Eur Urol 67(4):683–689CrossRef Capitanio U, Terrone C, Antonelli A et al (2015) Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. Eur Urol 67(4):683–689CrossRef
20.
Zurück zum Zitat Tan H-J, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC (2012) Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA 307(15):1629–1635CrossRef Tan H-J, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC (2012) Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA 307(15):1629–1635CrossRef
21.
Zurück zum Zitat Shuch B, Hanley J, Lai J et al (2013) Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer 119(16):2981–2989CrossRef Shuch B, Hanley J, Lai J et al (2013) Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer 119(16):2981–2989CrossRef
22.
Zurück zum Zitat Schiavina R, Borghesi M, Dababneh H et al (2015) Small renal masses managed with active surveillance: predictors of tumor growth rate after long-term follow-up. Clin Genitourin Cancer 13(2):e87–e92CrossRef Schiavina R, Borghesi M, Dababneh H et al (2015) Small renal masses managed with active surveillance: predictors of tumor growth rate after long-term follow-up. Clin Genitourin Cancer 13(2):e87–e92CrossRef
23.
Zurück zum Zitat May M, Cindolo L, Zigeuner R et al (2014) Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life. Urol Oncol 32(8):1252–1258CrossRef May M, Cindolo L, Zigeuner R et al (2014) Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life. Urol Oncol 32(8):1252–1258CrossRef
Metadaten
Titel
Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)
verfasst von
Maria C. Mir
Nicola Pavan
Umberto Capitanio
Alessandro Antonelli
Ithaar Derweesh
Oscar Rodriguez-Faba
Estefania Linares
Toshio Takagi
Koon H. Rha
Christian Fiori
Tobias Maurer
Chao Zang
Alexandre Mottrie
Paolo Umari
Jean-Alexandre Long
Gaelle Fiard
Cosimo De Nunzio
Andrea Tubaro
Andrew T. Tracey
Matteo Ferro
Ottavio De Cobelli
Salvatore Micali
Luigi Bevilacqua
João Torres
Luigi Schips
Roberto Castellucci
Ryan Dobbs
Giuseppe Quarto
Pierluigi Bove
Antonio Celia
Bernardino De Concilio
Carlo Trombetta
Tommaso Silvestri
Alessandro Larcher
Francesco Montorsi
Carlotta Palumbo
Maria Furlan
Ahmet Bindayi
Zachary Hamilton
Alberto Breda
Joan Palou
Alfredo Aguilera
Kazunari Tanabe
Ali Raheem
Thomas Amiel
Bo Yang
Estevão Lima
Simone Crivellaro
Sisto Perdona
Caterina Gregorio
Giulia Barbati
Francesco Porpiglia
Riccardo Autorino
Publikationsdatum
01.04.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
World Journal of Urology / Ausgabe 1/2020
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-019-02665-2

Weitere Artikel der Ausgabe 1/2020

World Journal of Urology 1/2020 Zur Ausgabe

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.