Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management
Standard
Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. / Sun, Maxine; Becker, Andreas; Tian, Zhe; Roghmann, Florian; Abdollah, Firas; Larouche, Alexandre; Karakiewicz, Pierre I; Trinh, Quoc-Dien.
in: EUR UROL, Jahrgang 65, Nr. 1, 01.01.2014, S. 235-241.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management
AU - Sun, Maxine
AU - Becker, Andreas
AU - Tian, Zhe
AU - Roghmann, Florian
AU - Abdollah, Firas
AU - Larouche, Alexandre
AU - Karakiewicz, Pierre I
AU - Trinh, Quoc-Dien
N1 - Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - BACKGROUND: For elderly individuals with localized renal cell carcinoma (RCC), surgical intervention remains the primary treatment option but may not benefit patients with limited life expectancy.OBJECTIVE: To calculate the trade-offs between surgical excision and nonsurgical management (NSM) with respect to competing causes of mortality.DESIGN, SETTING, AND PARTICIPANTS: Relying on a cohort of Medicare beneficiaries, all patients with nonmetastatic node-negative T1 RCC between 1988 and 2005 were abstracted.INTERVENTION: All patients were treated with partial nephrectomy (PN), radical nephrectomy (RN), or NSM.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cancer-specific mortality (CSM) and other-cause mortality (OCM) rates were modeled through competing-risks regression methodologies. Instrumental variable analysis was used to account for the potential biases associated with measured and unmeasured confounders.RESULTS AND LIMITATIONS: A total of 10 595 patients were identified. In instrumental variable analysis, patients treated with PN (hazard ratio [HR]: 0.45; 95% confidence interval [CI], 0.24-0.83; p=0.01) or RN (HR: 0.58; 95% CI, 0.35-0.96; p=0.03) had a significantly lower risk of CSM than those treated with NSM. In subanalyses restricted to patients ≥ 75 yr, the instrumental variable analysis failed to detect any statistically significant difference between PN (HR: 0.48; p=0.1) or RN (HR: 0.57; p=0.1) relative to NSM with respect to CSM. Similar trends were observed in T1a RCC only.CONCLUSIONS: PN or RN is associated with a reduction of CSM among older patients diagnosed with localized RCC, compared with NSM. The same benefit failed to reach statistical significance among patients ≥ 75 yr. The harms of surgery need to be weighed against the marginal survival benefit for some patients.
AB - BACKGROUND: For elderly individuals with localized renal cell carcinoma (RCC), surgical intervention remains the primary treatment option but may not benefit patients with limited life expectancy.OBJECTIVE: To calculate the trade-offs between surgical excision and nonsurgical management (NSM) with respect to competing causes of mortality.DESIGN, SETTING, AND PARTICIPANTS: Relying on a cohort of Medicare beneficiaries, all patients with nonmetastatic node-negative T1 RCC between 1988 and 2005 were abstracted.INTERVENTION: All patients were treated with partial nephrectomy (PN), radical nephrectomy (RN), or NSM.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cancer-specific mortality (CSM) and other-cause mortality (OCM) rates were modeled through competing-risks regression methodologies. Instrumental variable analysis was used to account for the potential biases associated with measured and unmeasured confounders.RESULTS AND LIMITATIONS: A total of 10 595 patients were identified. In instrumental variable analysis, patients treated with PN (hazard ratio [HR]: 0.45; 95% confidence interval [CI], 0.24-0.83; p=0.01) or RN (HR: 0.58; 95% CI, 0.35-0.96; p=0.03) had a significantly lower risk of CSM than those treated with NSM. In subanalyses restricted to patients ≥ 75 yr, the instrumental variable analysis failed to detect any statistically significant difference between PN (HR: 0.48; p=0.1) or RN (HR: 0.57; p=0.1) relative to NSM with respect to CSM. Similar trends were observed in T1a RCC only.CONCLUSIONS: PN or RN is associated with a reduction of CSM among older patients diagnosed with localized RCC, compared with NSM. The same benefit failed to reach statistical significance among patients ≥ 75 yr. The harms of surgery need to be weighed against the marginal survival benefit for some patients.
KW - Aged
KW - Aged, 80 and over
KW - Carcinoma, Renal Cell
KW - Female
KW - Humans
KW - Kidney Neoplasms
KW - Male
KW - Nephrectomy
KW - Retrospective Studies
KW - Risk Assessment
KW - Survival Rate
U2 - 10.1016/j.eururo.2013.03.034
DO - 10.1016/j.eururo.2013.03.034
M3 - SCORING: Journal article
C2 - 23567066
VL - 65
SP - 235
EP - 241
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 1
ER -