Abstract
Background
We reviewed the outcomes for an octogenarian population to investigate whether active
surveillance (AS) provides comparable survival to partial nephrectomy (PN) or radical
nephrectomy (RN).
Patients and Methods
Data were collected from 115 octogenarian patients referred for management of renal
masses at Moffitt Cancer Center from 2000 to 2013. Patients were treated with AS,
PN, or RN. Univariable and multivariable Cox regression models measured the association
between management modality and survival. Kaplan-Meier survival analysis was used
to calculate survival, and log-rank tests were used to compare survival curves.
Results
The median age was 82 years (interquartile range, 81-85 years). The median follow-up
period was 51 months (interquartile range, 23-81 months). Of the 115 patients, 31
(27%) underwent AS, 31 (27%) underwent PN, and 53 (46%) underwent RN. The patients
who underwent RN had a larger mean tumor size at 5.5 cm, with 19 patients (36%) having
stage ≥ pT3 (P < .001). We found no difference in overall survival or disease-specific survival
among the 3 management strategies on univariable analysis (P = .39 and P = .1, respectively). On multivariable analysis for overall survival, only the Charlson
comorbidity index was associated with worse survival (hazard ratio, 1.2; 95% confidence
interval, 1.1-1.3; P = .002). In a subgroup analysis of cT1a patients, we also found no difference in
overall or disease-specific survival among the treatment arms on univariable analysis
(P = .74 and P = .9, respectively).
Conclusion
Active treatment with PN and RN might not provide a survival advantage compared with
AS in the octogenarian population with a small renal mass. However, larger renal masses
should undergo active treatment in appropriately selected patients.
Keywords
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References
- Cancer statistics, 2016.CA Cancer J. 2016; 66: 7-30
- Rising incidence of renal cell cancer in the United States.JAMA. 1999; 281: 1628-1631
- Kidney cancer, version 3.2015.J Natl Compr Canc Netw. 2015; 13: 151-159
- The natural history of incidentally detected small renal masses.Cancer. 2004; 100: 738-745
- Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy.BJU Int. 2012; 110: 1270-1275
- Incidentally discovered renal masses: oncological and perioperative outcomes in patients with delayed surgical intervention.BJU Int. 2009; 103: 1355-1358
- Management of small kidney cancers in the new millennium: contemporary trends and outcomes in a population-based cohort.JAMA Surg. 2015; 150: 664-672
- National treatment trends among older patients with T1-localized renal cell carcinoma.Urol Oncol. 2016; 35: 113.e15-113.e21
- United States life tables, 2010.Natl Vital Stat Rep. 2014; 63: 1-63
- Assessing the burden of complications after surgery for clinically localized kidney cancer by age and comorbidity status.Urology. 2014; 83: 843-849
- Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older.Cancer. 2010; 116: 3119-3126
Celtik KE, Shah PH, Patel VR, et al. Active surveillance for incidental renal mass in the octogenarian [e-pub ahead of print]. World J Urol. http://dx.doi.org/10.1007/s00345-016-1961-9, accessed November 1, 2016.
- Implications on clinical management of the small renal mass in patients 80 years of age and older based on a retrospective review of the SEER database.Int Urol Nephrol. 2015; 47: 1503-1508
- Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?.BJU Int. 2009; 103: 1492-1495
- Active surveillance of renal masses in elderly patients.J Urol. 2008; 180: 505-509
- The natural history of observed enhancing renal masses: meta-analysis and review of the world literature.J Urol. 2006; 175: 425-431
- Penile cancer: Clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2013; 11: 594-615
- EAU guidelines on penile cancer: 2014 update.Eur Urol. 2015; 67: 142-150
- Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry.Eur Urol. 2015; 68: 408-415
- Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy.Urology. 2004; 64: 49-52
- Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis.Cancer. 2012; 118: 997-1006
- A population-based comparison of survival after nephrectomy vs nonsurgical management for small renal masses.BJU Int. 2009; 103: 899-904
- Survival after diagnosis of localized T1a kidney cancer: current population-based practice of surgery and nonsurgical management.Urology. 2014; 83: 126-132
- Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.N Engl J Med. 2004; 351: 1296-1305
Article info
Publication history
Published online: May 09, 2017
Accepted:
May 1,
2017
Received in revised form:
April 26,
2017
Received:
February 3,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
