Survival After Diagnosis of Localized T1a Kidney Cancer: Current Population-based Practice of Surgery and Nonsurgical Management
Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, surviv...
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| Veröffentlicht in: | Urology (Ridgewood, N.J.) N.J.), 2014, Vol.83 (1), p.126-133 |
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| creator | Patel, Hiten D Kates, Max Pierorazio, Phillip M Hyams, Elias S Gorin, Michael A Ball, Mark W Bhayani, Sam B Hui, Xuan Thompson, Carol B Allaf, Mohamad E |
| description | Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results–Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5%) underwent NSM, 1849 (25.8%) PN, and 4574 (63.7%) RN, with 436 (57.8%), 389 (21.0%), and 1598 (34.9%) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95% CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95% CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients ( |
| doi_str_mv | 10.1016/j.urology.2013.08.088 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1490742034</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0090429513012600</els_id><sourcerecordid>1490742034</sourcerecordid><originalsourceid>FETCH-LOGICAL-c563t-51ee9c90d42120b454cdcb9a0711e5ea4a7d679deac4c72bbc6e2748a59837643</originalsourceid><addsrcrecordid>eNqFkk2LFDEQhoMo7rj6E5RcBC89VtLpTseDsoyfOOrCrueQTlcPGXuSMekeGE_-dNPMqOBFKCgCT70pHoqQxwyWDFj9fLucYhjC5rjkwMolNLmaO2TBKi4LpVR1lywAFBSCq-qCPEhpCwB1Xcv75IILLuqSyQX5eTPFgzuYgV71I0b62pmND8klGnq6DtYM7gd29JYZ-tF1Ho90ZbzF-IKuphjRj_Q67KfBjC74ojUps9fR2NFZnBNy-gbjkRrf0c_Bp_x0OZN-Mt5scJfnH5J7vRkSPjr3S_L17Zvb1fti_eXdh9XVurBVXY5FxRCVVdAJzji0ohK2s60yIBnDCo0wsqul6tBYYSVvW1sjl6IxlWpKWYvykjw75e5j-D5hGvXOJYvDYDyGKWkmFEjBoZzR6oTaGFKK2Ot9dDsTj5qBnuXrrT7L17N8DU2uJs89OX8xtTvs_kz9tp2Bp2fApGyhj1mlS3-5piwZk_MCr04cZiEHh1En6zBr71xEO-ouuP-u8vKfBDs4P6v_hkdM2zBFn21rphPXoG_mS5kPhZXAeA1Q_gJiP7uw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490742034</pqid></control><display><type>article</type><title>Survival After Diagnosis of Localized T1a Kidney Cancer: Current Population-based Practice of Surgery and Nonsurgical Management</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Patel, Hiten D ; Kates, Max ; Pierorazio, Phillip M ; Hyams, Elias S ; Gorin, Michael A ; Ball, Mark W ; Bhayani, Sam B ; Hui, Xuan ; Thompson, Carol B ; Allaf, Mohamad E</creator><creatorcontrib>Patel, Hiten D ; Kates, Max ; Pierorazio, Phillip M ; Hyams, Elias S ; Gorin, Michael A ; Ball, Mark W ; Bhayani, Sam B ; Hui, Xuan ; Thompson, Carol B ; Allaf, Mohamad E</creatorcontrib><description>Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results–Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5%) underwent NSM, 1849 (25.8%) PN, and 4574 (63.7%) RN, with 436 (57.8%), 389 (21.0%), and 1598 (34.9%) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95% CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95% CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients (<75 years), whereas there was an excess of kidney cancer deaths for NSM patients aged 75-79 years and an attenuated difference for patients aged 80 years or older. Conclusion NSM was associated with an increased risk of kidney cancer death among Medicare beneficiaries aged 75-79 years. Evolving active surveillance protocols will need to develop robust selection criteria to maximize cancer survival for older patients with kidney cancer.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2013.08.088</identifier><identifier>PMID: 24246317</identifier><identifier>CODEN: URGYAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Humans ; Kidney Neoplasms - mortality ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Kidney Neoplasms - therapy ; Kidneys ; Medical sciences ; Multiple tumors. Solid tumors. Tumors in childhood (general aspects) ; Neoplasm Staging ; Nephrectomy ; Nephrology. Urinary tract diseases ; Retrospective Studies ; Survival Rate ; Tumors ; Tumors of the urinary system ; Urology</subject><ispartof>Urology (Ridgewood, N.J.), 2014, Vol.83 (1), p.126-133</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c563t-51ee9c90d42120b454cdcb9a0711e5ea4a7d679deac4c72bbc6e2748a59837643</citedby><cites>FETCH-LOGICAL-c563t-51ee9c90d42120b454cdcb9a0711e5ea4a7d679deac4c72bbc6e2748a59837643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urology.2013.08.088$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,4024,27923,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28331174$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24246317$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Hiten D</creatorcontrib><creatorcontrib>Kates, Max</creatorcontrib><creatorcontrib>Pierorazio, Phillip M</creatorcontrib><creatorcontrib>Hyams, Elias S</creatorcontrib><creatorcontrib>Gorin, Michael A</creatorcontrib><creatorcontrib>Ball, Mark W</creatorcontrib><creatorcontrib>Bhayani, Sam B</creatorcontrib><creatorcontrib>Hui, Xuan</creatorcontrib><creatorcontrib>Thompson, Carol B</creatorcontrib><creatorcontrib>Allaf, Mohamad E</creatorcontrib><title>Survival After Diagnosis of Localized T1a Kidney Cancer: Current Population-based Practice of Surgery and Nonsurgical Management</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results–Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5%) underwent NSM, 1849 (25.8%) PN, and 4574 (63.7%) RN, with 436 (57.8%), 389 (21.0%), and 1598 (34.9%) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95% CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95% CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients (<75 years), whereas there was an excess of kidney cancer deaths for NSM patients aged 75-79 years and an attenuated difference for patients aged 80 years or older. Conclusion NSM was associated with an increased risk of kidney cancer death among Medicare beneficiaries aged 75-79 years. Evolving active surveillance protocols will need to develop robust selection criteria to maximize cancer survival for older patients with kidney cancer.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Humans</subject><subject>Kidney Neoplasms - mortality</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Kidney Neoplasms - therapy</subject><subject>Kidneys</subject><subject>Medical sciences</subject><subject>Multiple tumors. Solid tumors. Tumors in childhood (general aspects)</subject><subject>Neoplasm Staging</subject><subject>Nephrectomy</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Tumors</subject><subject>Tumors of the urinary system</subject><subject>Urology</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk2LFDEQhoMo7rj6E5RcBC89VtLpTseDsoyfOOrCrueQTlcPGXuSMekeGE_-dNPMqOBFKCgCT70pHoqQxwyWDFj9fLucYhjC5rjkwMolNLmaO2TBKi4LpVR1lywAFBSCq-qCPEhpCwB1Xcv75IILLuqSyQX5eTPFgzuYgV71I0b62pmND8klGnq6DtYM7gd29JYZ-tF1Ho90ZbzF-IKuphjRj_Q67KfBjC74ojUps9fR2NFZnBNy-gbjkRrf0c_Bp_x0OZN-Mt5scJfnH5J7vRkSPjr3S_L17Zvb1fti_eXdh9XVurBVXY5FxRCVVdAJzji0ohK2s60yIBnDCo0wsqul6tBYYSVvW1sjl6IxlWpKWYvykjw75e5j-D5hGvXOJYvDYDyGKWkmFEjBoZzR6oTaGFKK2Ot9dDsTj5qBnuXrrT7L17N8DU2uJs89OX8xtTvs_kz9tp2Bp2fApGyhj1mlS3-5piwZk_MCr04cZiEHh1En6zBr71xEO-ouuP-u8vKfBDs4P6v_hkdM2zBFn21rphPXoG_mS5kPhZXAeA1Q_gJiP7uw</recordid><startdate>2014</startdate><enddate>2014</enddate><creator>Patel, Hiten D</creator><creator>Kates, Max</creator><creator>Pierorazio, Phillip M</creator><creator>Hyams, Elias S</creator><creator>Gorin, Michael A</creator><creator>Ball, Mark W</creator><creator>Bhayani, Sam B</creator><creator>Hui, Xuan</creator><creator>Thompson, Carol B</creator><creator>Allaf, Mohamad E</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2014</creationdate><title>Survival After Diagnosis of Localized T1a Kidney Cancer: Current Population-based Practice of Surgery and Nonsurgical Management</title><author>Patel, Hiten D ; Kates, Max ; Pierorazio, Phillip M ; Hyams, Elias S ; Gorin, Michael A ; Ball, Mark W ; Bhayani, Sam B ; Hui, Xuan ; Thompson, Carol B ; Allaf, Mohamad E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c563t-51ee9c90d42120b454cdcb9a0711e5ea4a7d679deac4c72bbc6e2748a59837643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Humans</topic><topic>Kidney Neoplasms - mortality</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Kidney Neoplasms - therapy</topic><topic>Kidneys</topic><topic>Medical sciences</topic><topic>Multiple tumors. Solid tumors. Tumors in childhood (general aspects)</topic><topic>Neoplasm Staging</topic><topic>Nephrectomy</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Tumors</topic><topic>Tumors of the urinary system</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Hiten D</creatorcontrib><creatorcontrib>Kates, Max</creatorcontrib><creatorcontrib>Pierorazio, Phillip M</creatorcontrib><creatorcontrib>Hyams, Elias S</creatorcontrib><creatorcontrib>Gorin, Michael A</creatorcontrib><creatorcontrib>Ball, Mark W</creatorcontrib><creatorcontrib>Bhayani, Sam B</creatorcontrib><creatorcontrib>Hui, Xuan</creatorcontrib><creatorcontrib>Thompson, Carol B</creatorcontrib><creatorcontrib>Allaf, Mohamad E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Hiten D</au><au>Kates, Max</au><au>Pierorazio, Phillip M</au><au>Hyams, Elias S</au><au>Gorin, Michael A</au><au>Ball, Mark W</au><au>Bhayani, Sam B</au><au>Hui, Xuan</au><au>Thompson, Carol B</au><au>Allaf, Mohamad E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival After Diagnosis of Localized T1a Kidney Cancer: Current Population-based Practice of Surgery and Nonsurgical Management</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2014</date><risdate>2014</risdate><volume>83</volume><issue>1</issue><spage>126</spage><epage>133</epage><pages>126-133</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><coden>URGYAZ</coden><abstract>Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results–Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5%) underwent NSM, 1849 (25.8%) PN, and 4574 (63.7%) RN, with 436 (57.8%), 389 (21.0%), and 1598 (34.9%) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95% CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95% CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients (<75 years), whereas there was an excess of kidney cancer deaths for NSM patients aged 75-79 years and an attenuated difference for patients aged 80 years or older. Conclusion NSM was associated with an increased risk of kidney cancer death among Medicare beneficiaries aged 75-79 years. Evolving active surveillance protocols will need to develop robust selection criteria to maximize cancer survival for older patients with kidney cancer.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>24246317</pmid><doi>10.1016/j.urology.2013.08.088</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Biological and medical sciences Humans Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery Kidney Neoplasms - therapy Kidneys Medical sciences Multiple tumors. Solid tumors. Tumors in childhood (general aspects) Neoplasm Staging Nephrectomy Nephrology. Urinary tract diseases Retrospective Studies Survival Rate Tumors Tumors of the urinary system Urology |
| title | Survival After Diagnosis of Localized T1a Kidney Cancer: Current Population-based Practice of Surgery and Nonsurgical Management |
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