Partial versus radical nephrectomy in very elderly patients

TY - JOUR

T1 - Partial versus radical nephrectomy in very elderly patients

T2 - a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

AU - Mir, Maria C

AU - Pavan, Nicola

AU - Capitanio, Umberto

AU - Antonelli, Alessandro

AU - Derweesh, Ithaar

AU - Rodriguez-Faba, Oscar

AU - Linares, Estefania

AU - Takagi, Toshio

AU - Rha, Koon H

AU - Fiori, Christian

AU - Maurer, Tobias

AU - Zang, Chao

AU - Mottrie, Alexandre

AU - Umari, Paolo

AU - Long, Jean-Alexandre

AU - Fiard, Gaelle

AU - De Nunzio, Cosimo

AU - Tubaro, Andrea

AU - Tracey, Andrew T

AU - Ferro, Matteo

AU - De Cobelli, Ottavio

AU - Micali, Salvatore

AU - Bevilacqua, Luigi

AU - Torres, João

AU - Schips, Luigi

AU - Castellucci, Roberto

AU - Dobbs, Ryan

AU - Quarto, Giuseppe

AU - Bove, Pierluigi

AU - Celia, Antonio

AU - De Concilio, Bernardino

AU - Trombetta, Carlo

AU - Silvestri, Tommaso

AU - Larcher, Alessandro

AU - Montorsi, Francesco

AU - Palumbo, Carlotta

AU - Furlan, Maria

AU - Bindayi, Ahmet

AU - Hamilton, Zachary

AU - Breda, Alberto

AU - Palou, Joan

AU - Aguilera, Alfredo

AU - Tanabe, Kazunari

AU - Raheem, Ali

AU - Amiel, Thomas

AU - Yang, Bo

AU - Lima, Estevão

AU - Crivellaro, Simone

AU - Perdona, Sisto

AU - Gregorio, Caterina

AU - Barbati, Giulia

AU - Porpiglia, Francesco

AU - Autorino, Riccardo

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - Age Factors

KW - Aged

KW - Asia/epidemiology

KW - Carcinoma, Renal Cell/diagnosis

KW - Europe/epidemiology

KW - Female

KW - Glomerular Filtration Rate

KW - Humans

KW - Incidence

KW - Kidney Neoplasms/diagnosis

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Nephrectomy/methods

KW - North America/epidemiology

KW - Postoperative Complications/epidemiology

KW - Propensity Score

KW - Retrospective Studies

KW - Survival Rate/trends

KW - Treatment Outcome

U2 - 10.1007/s00345-019-02665-2

DO - 10.1007/s00345-019-02665-2

M3 - SCORING: Journal article

C2 - 30937569

VL - 38

SP - 151

EP - 158

JO - WORLD J UROL

JF - WORLD J UROL

SN - 0724-4983

IS - 1

ER -