Partial versus radical nephrectomy in very elderly patients
Standard
Partial versus radical nephrectomy in very elderly patients : a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project). / Mir, Maria C; Pavan, Nicola; Capitanio, Umberto; Antonelli, Alessandro; Derweesh, Ithaar; Rodriguez-Faba, Oscar; Linares, Estefania; Takagi, Toshio; Rha, Koon H; Fiori, Christian; Maurer, Tobias; Zang, Chao; Mottrie, Alexandre; Umari, Paolo; Long, Jean-Alexandre; Fiard, Gaelle; De Nunzio, Cosimo; Tubaro, Andrea; Tracey, Andrew T; Ferro, Matteo; De Cobelli, Ottavio; Micali, Salvatore; Bevilacqua, Luigi; Torres, João; Schips, Luigi; Castellucci, Roberto; Dobbs, Ryan; Quarto, Giuseppe; Bove, Pierluigi; Celia, Antonio; De Concilio, Bernardino; Trombetta, Carlo; Silvestri, Tommaso; Larcher, Alessandro; Montorsi, Francesco; Palumbo, Carlotta; Furlan, Maria; Bindayi, Ahmet; Hamilton, Zachary; Breda, Alberto; Palou, Joan; Aguilera, Alfredo; Tanabe, Kazunari; Raheem, Ali; Amiel, Thomas; Yang, Bo; Lima, Estevão; Crivellaro, Simone; Perdona, Sisto; Gregorio, Caterina; Barbati, Giulia; Porpiglia, Francesco; Autorino, Riccardo.
In: WORLD J UROL, Vol. 38, No. 1, 01.2020, p. 151-158.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
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 -