Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older
BACKGROUND: Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to inve...
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description | BACKGROUND:
Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to investigate whether surgical intervention improved survival compared with active surveillance.
METHODS:
Clinical T1 renal tumors were managed with surveillance (20%), nephron‐sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables.
RESULTS:
The median follow‐up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan‐Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron‐sparing intervention (P = .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P = .0004) and comorbidity (P < .0001) but not management type (P = .3). Preoperative renal function (P = .006) and comorbidity (P = .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function.
CONCLUSIONS:
In patients aged ≥75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010. © 2010 American Cancer Society.
In patients aged ≥75 years, surgical management of clinically localized renal tumors (by either nephrectomy or any nephron‐sparing intervention) was not associated with increased survival after adjusting for age and comorbidity. Patients died mostly of cardiovascular causes, and nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality, suggesting the possibility of over treatment in these patients with limited life expectancy. |
doi_str_mv | 10.1002/cncr.25184 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_733305959</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>733305959</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3944-d6dff741957f17607c0abcf44f0d487992b326729d183ed52dfd5c84f21dd7e53</originalsourceid><addsrcrecordid>eNp90F1rFDEUBuBQlO529cYfILkRQZiaz8nksizVFoqCtODdkE1OJCUzWZOZlfXXm3W39c6rw4HnvAdehN5QckkJYR_taPMlk7QTZ2hJiVYNoYK9QEtCSNdIwb8v0EUpj3VVTPJztGBEtqJlaomGKzuFHeApg5kGGCecPI7Jmhh-g8MZRhPxNA8pFzyYPR7ThMOwNbbCHWQTIy5z3oVdZWHEWzOFGlKw-VGvlcR7MPUyZZyig_wKvfQmFnh9miv08On6fn3T3H39fLu-umss10I0rnXeK0G1VJ6qlihLzMZ6ITxxolNasw1nrWLa0Y6Dk8x5J20nPKPOKZB8hd4fc7c5_ZyhTP0QioUYzQhpLr3inBOppa7yw1HanErJ4PttDoPJ-56S_tBuf2i3_9tuxW9PsfNmAPdMn-qs4N0JmFIr9NmMNpR_jmlCtaDV0aP7FSLs__OyX39Zfzs-_wNrPZKq</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>733305959</pqid></control><display><type>article</type><title>Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older</title><source>Wiley Online Library website</source><source>MEDLINE</source><source>Wiley Online Library Journals</source><source>Free E-Journal (出版社公開部分のみ)</source><source>Alma/SFX Local Collection</source><creator>Lane, Brian R. ; Abouassaly, Robert ; Gao, Tianming ; Weight, Christopher J. ; Hernandez, Adrian V. ; Larson, Benjamin T. ; Kaouk, Jihad H. ; Gill, Inderbir S. ; Campbell, Steven C.</creator><creatorcontrib>Lane, Brian R. ; Abouassaly, Robert ; Gao, Tianming ; Weight, Christopher J. ; Hernandez, Adrian V. ; Larson, Benjamin T. ; Kaouk, Jihad H. ; Gill, Inderbir S. ; Campbell, Steven C.</creatorcontrib><description>BACKGROUND:
Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to investigate whether surgical intervention improved survival compared with active surveillance.
METHODS:
Clinical T1 renal tumors were managed with surveillance (20%), nephron‐sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables.
RESULTS:
The median follow‐up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan‐Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron‐sparing intervention (P = .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P = .0004) and comorbidity (P < .0001) but not management type (P = .3). Preoperative renal function (P = .006) and comorbidity (P = .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function.
CONCLUSIONS:
In patients aged ≥75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010. © 2010 American Cancer Society.
In patients aged ≥75 years, surgical management of clinically localized renal tumors (by either nephrectomy or any nephron‐sparing intervention) was not associated with increased survival after adjusting for age and comorbidity. Patients died mostly of cardiovascular causes, and nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality, suggesting the possibility of over treatment in these patients with limited life expectancy.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.25184</identifier><identifier>PMID: 20564627</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Carcinoma, Renal Cell - mortality ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - mortality ; Cause of Death ; chronic ; comorbidity ; Female ; glomerular filtration rate ; Health Services Misuse ; Humans ; kidney failure ; Kidney Neoplasms - mortality ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Kidneys ; Male ; Medical sciences ; Neoplasm Metastasis ; nephrectomy ; Nephrectomy - methods ; Nephrectomy - trends ; Nephrology. Urinary tract diseases ; observation ; Prognosis ; renal neoplasm ; surveillance ; Survival Analysis ; Tumors ; Tumors of the urinary system</subject><ispartof>Cancer, 2010-07, Vol.116 (13), p.3119-3126</ispartof><rights>Copyright © 2010 American Cancer Society</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3944-d6dff741957f17607c0abcf44f0d487992b326729d183ed52dfd5c84f21dd7e53</citedby><cites>FETCH-LOGICAL-c3944-d6dff741957f17607c0abcf44f0d487992b326729d183ed52dfd5c84f21dd7e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.25184$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.25184$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22901941$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20564627$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lane, Brian R.</creatorcontrib><creatorcontrib>Abouassaly, Robert</creatorcontrib><creatorcontrib>Gao, Tianming</creatorcontrib><creatorcontrib>Weight, Christopher J.</creatorcontrib><creatorcontrib>Hernandez, Adrian V.</creatorcontrib><creatorcontrib>Larson, Benjamin T.</creatorcontrib><creatorcontrib>Kaouk, Jihad H.</creatorcontrib><creatorcontrib>Gill, Inderbir S.</creatorcontrib><creatorcontrib>Campbell, Steven C.</creatorcontrib><title>Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND:
Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to investigate whether surgical intervention improved survival compared with active surveillance.
METHODS:
Clinical T1 renal tumors were managed with surveillance (20%), nephron‐sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables.
RESULTS:
The median follow‐up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan‐Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron‐sparing intervention (P = .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P = .0004) and comorbidity (P < .0001) but not management type (P = .3). Preoperative renal function (P = .006) and comorbidity (P = .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function.
CONCLUSIONS:
In patients aged ≥75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010. © 2010 American Cancer Society.
In patients aged ≥75 years, surgical management of clinically localized renal tumors (by either nephrectomy or any nephron‐sparing intervention) was not associated with increased survival after adjusting for age and comorbidity. Patients died mostly of cardiovascular causes, and nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality, suggesting the possibility of over treatment in these patients with limited life expectancy.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Renal Cell - mortality</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Cardiovascular Diseases - complications</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cause of Death</subject><subject>chronic</subject><subject>comorbidity</subject><subject>Female</subject><subject>glomerular filtration rate</subject><subject>Health Services Misuse</subject><subject>Humans</subject><subject>kidney failure</subject><subject>Kidney Neoplasms - mortality</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neoplasm Metastasis</subject><subject>nephrectomy</subject><subject>Nephrectomy - methods</subject><subject>Nephrectomy - trends</subject><subject>Nephrology. Urinary tract diseases</subject><subject>observation</subject><subject>Prognosis</subject><subject>renal neoplasm</subject><subject>surveillance</subject><subject>Survival Analysis</subject><subject>Tumors</subject><subject>Tumors of the urinary system</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90F1rFDEUBuBQlO529cYfILkRQZiaz8nksizVFoqCtODdkE1OJCUzWZOZlfXXm3W39c6rw4HnvAdehN5QckkJYR_taPMlk7QTZ2hJiVYNoYK9QEtCSNdIwb8v0EUpj3VVTPJztGBEtqJlaomGKzuFHeApg5kGGCecPI7Jmhh-g8MZRhPxNA8pFzyYPR7ThMOwNbbCHWQTIy5z3oVdZWHEWzOFGlKw-VGvlcR7MPUyZZyig_wKvfQmFnh9miv08On6fn3T3H39fLu-umss10I0rnXeK0G1VJ6qlihLzMZ6ITxxolNasw1nrWLa0Y6Dk8x5J20nPKPOKZB8hd4fc7c5_ZyhTP0QioUYzQhpLr3inBOppa7yw1HanErJ4PttDoPJ-56S_tBuf2i3_9tuxW9PsfNmAPdMn-qs4N0JmFIr9NmMNpR_jmlCtaDV0aP7FSLs__OyX39Zfzs-_wNrPZKq</recordid><startdate>20100701</startdate><enddate>20100701</enddate><creator>Lane, Brian R.</creator><creator>Abouassaly, Robert</creator><creator>Gao, Tianming</creator><creator>Weight, Christopher J.</creator><creator>Hernandez, Adrian V.</creator><creator>Larson, Benjamin T.</creator><creator>Kaouk, Jihad H.</creator><creator>Gill, Inderbir S.</creator><creator>Campbell, Steven C.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley-Blackwell</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>20100701</creationdate><title>Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older</title><author>Lane, Brian R. ; Abouassaly, Robert ; Gao, Tianming ; Weight, Christopher J. ; Hernandez, Adrian V. ; Larson, Benjamin T. ; Kaouk, Jihad H. ; Gill, Inderbir S. ; Campbell, Steven C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3944-d6dff741957f17607c0abcf44f0d487992b326729d183ed52dfd5c84f21dd7e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Renal Cell - mortality</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Cardiovascular Diseases - complications</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cause of Death</topic><topic>chronic</topic><topic>comorbidity</topic><topic>Female</topic><topic>glomerular filtration rate</topic><topic>Health Services Misuse</topic><topic>Humans</topic><topic>kidney failure</topic><topic>Kidney Neoplasms - mortality</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Neoplasm Metastasis</topic><topic>nephrectomy</topic><topic>Nephrectomy - methods</topic><topic>Nephrectomy - trends</topic><topic>Nephrology. Urinary tract diseases</topic><topic>observation</topic><topic>Prognosis</topic><topic>renal neoplasm</topic><topic>surveillance</topic><topic>Survival Analysis</topic><topic>Tumors</topic><topic>Tumors of the urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lane, Brian R.</creatorcontrib><creatorcontrib>Abouassaly, Robert</creatorcontrib><creatorcontrib>Gao, Tianming</creatorcontrib><creatorcontrib>Weight, Christopher J.</creatorcontrib><creatorcontrib>Hernandez, Adrian V.</creatorcontrib><creatorcontrib>Larson, Benjamin T.</creatorcontrib><creatorcontrib>Kaouk, Jihad H.</creatorcontrib><creatorcontrib>Gill, Inderbir S.</creatorcontrib><creatorcontrib>Campbell, Steven C.</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>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lane, Brian R.</au><au>Abouassaly, Robert</au><au>Gao, Tianming</au><au>Weight, Christopher J.</au><au>Hernandez, Adrian V.</au><au>Larson, Benjamin T.</au><au>Kaouk, Jihad H.</au><au>Gill, Inderbir S.</au><au>Campbell, Steven C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2010-07-01</date><risdate>2010</risdate><volume>116</volume><issue>13</issue><spage>3119</spage><epage>3126</epage><pages>3119-3126</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND:
Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to investigate whether surgical intervention improved survival compared with active surveillance.
METHODS:
Clinical T1 renal tumors were managed with surveillance (20%), nephron‐sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables.
RESULTS:
The median follow‐up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan‐Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron‐sparing intervention (P = .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P = .0004) and comorbidity (P < .0001) but not management type (P = .3). Preoperative renal function (P = .006) and comorbidity (P = .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function.
CONCLUSIONS:
In patients aged ≥75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010. © 2010 American Cancer Society.
In patients aged ≥75 years, surgical management of clinically localized renal tumors (by either nephrectomy or any nephron‐sparing intervention) was not associated with increased survival after adjusting for age and comorbidity. Patients died mostly of cardiovascular causes, and nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality, suggesting the possibility of over treatment in these patients with limited life expectancy.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>20564627</pmid><doi>10.1002/cncr.25184</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 Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Cardiovascular Diseases - complications Cardiovascular Diseases - mortality Cause of Death chronic comorbidity Female glomerular filtration rate Health Services Misuse Humans kidney failure Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery Kidneys Male Medical sciences Neoplasm Metastasis nephrectomy Nephrectomy - methods Nephrectomy - trends Nephrology. Urinary tract diseases observation Prognosis renal neoplasm surveillance Survival Analysis Tumors Tumors of the urinary system |
title | Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older |
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