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01.04.2019 | Original Article | Ausgabe 1/2020

World Journal of Urology 1/2020

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

Zeitschrift:
World Journal of Urology > Ausgabe 1/2020
Autoren:
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
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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.

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