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Liu X, Huang X, Zhao P, Zhang P. Survival benefit of nephron-sparing surgery for patients with pT1b renal cell carcinoma: A population-based study. Oncol Lett 2020; 19:498-504. [PMID: 31897163 DOI: 10.3892/ol.2019.11065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/15/2019] [Indexed: 02/05/2023] Open
Abstract
The use of partial nephrectomy (PN) to treat patients with large renal cell carcinoma (RCC) remains controversial, particularly among elderly patients. The present study compared the improvement in cancer-specific survival (CSS) in patients with pT1b RCC who underwent either PN or radical nephrectomy (RN) and investigated the effects of age and sex on CSS. A total of 20,343 patients were identified in the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and Cox regression analysis were used to compare the CSS of patients who received PN vs. those who received RN. In total, 5,375 (26.42%) and 14,968 (73.58%) patients with pT1b RCC received PN and RN, respectively. Kaplan-Meier and Cox regression analysis indicated that PN resulted in an improved CSS compared with RN (P<0.001). In addition, PN was observed to be beneficial in male (P<0.001) and female patients <75 years of age. However, it was not beneficial for female patients of ≥75 years of age (P=0.197). These preliminary results warrant further investigation in clinical trials.
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Affiliation(s)
- Xiaode Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Xuemei Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Pan Zhao
- Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Peng Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Rodríguez-Covarrubias F, Rivera-Ramirez J, Gabilondo-Pliego B, Castillejos-Molina R, Sotomayor M, Feria-Bernal G, Gabilondo-Navarro F. Surgical treatment of renal-cell carcinoma in elderly people. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.acuroe.2016.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Surgical treatment of renal-cell carcinoma in elderly people. Actas Urol Esp 2016; 40:395-9. [PMID: 26968524 DOI: 10.1016/j.acuro.2016.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the oncological characteristics and evolution of patients 65 years or older who underwent surgery for renal-cell carcinoma (RCC). METHODS We reviewed our prospectively maintained database of patients with RCC treated surgically. Those ≥ 65 years old were selected. We analyzed clinical and pathological characteristics as well as oncological and functional outcomes. Overall survival (OS) was estimated with the Kaplan-Meier method. Multivariate Cox-proportional hazards model was used to determine predictors of OS. RESULTS A total of 156 elderly patients with mean age 72.0±5.5 years (range 65-92) and median follow-up of 33 months were included. Surgical approach was open radical nephrectomy in 114 (73.5%), laparoscopic radical nephrectomy in 13 (8.4%), open partial nephrectomy in 23 (14.2%) and laparoscopic partial nephrectomy in 6 (3.9%). Pathological stage was: Stage I, 71 (45.5%); Stage II, 27 (17.3%); Stage III, 48 (30.8%); and Stage IV, 10 (6.4%). Lastly, 51 (32.6%) patients died, 22 (43.1%) from cancer. The 5-year OS according to pathological stage was 77.6%, 71.9%, 45.1% and 11.7% for stage I, II, III and IV, respectively (P<.001). On multivariate analysis, pathological stage independently predicted OS (HR 1.96, 95% CI [1.36-2.84], P=.0003). CONCLUSIONS The surgical management of RCC appears to be safe in properly selected patients 65 years or older. Pathological stage predicts survival in this population.
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Miller AJ, Kurup AN, Schmit GD, Weisbrod AJ, Boorjian SA, Thompson RH, Lohse CM, Kor DJ, Callstrom MR, Atwell TD. Percutaneous Clinical T1a Renal Mass Ablation in the Octogenarian and Nonagenarian: Oncologic Outcomes and Morbidity. J Endourol 2015; 29:671-6. [DOI: 10.1089/end.2014.0733] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Christine M. Lohse
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Darryl J. Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
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Laparoscopic Radical Nephrectomy vs Laparoscopic or Open Partial Nephrectomy for T1 Renal Cell Carcinoma: Comparison of Complication Rates in Elderly Patients During the Initial Phase of Adoption. Urology 2014; 83:1285-91. [DOI: 10.1016/j.urology.2014.01.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/01/2014] [Accepted: 01/14/2014] [Indexed: 11/19/2022]
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Quivy A, Daste A, Harbaoui A, Duc S, Bernhard JC, Gross-Goupil M, Ravaud A. Optimal management of renal cell carcinoma in the elderly: a review. Clin Interv Aging 2013; 8:433-42. [PMID: 23626463 PMCID: PMC3632583 DOI: 10.2147/cia.s30765] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Both the aging population and the incidence of renal cell carcinoma (RCC) are growing, making the question of tumor management in the elderly a real challenge. Doctors should be aware of the importance of assessing this specific subpopulation. An aggressive therapeutic approach may be balanced by the benefit of the treatment - care or cure - and the life expectancy and willingness of the patient. The treatment for local disease can be surgery (radical or partial nephrectomy) or ablative therapies (radiofrequency, cryotherapy). Even if in most cases surgery is safe, complications such as alteration of renal function may occur, especially in the elderly, with physiological renal impairment at baseline. More recently, another option has been developed as an alternative: active surveillance. In the past decade, new drugs have been approved in the metastatic setting. All the phase 3 trials have included patients without a limit on age. Nevertheless, data concerning the elderly are still poor and concern only a very selective subpopulation. The toxicity profile of targeted agents may interfere with pre-existent comorbidities. Furthermore, the metabolism of several agents via cytochrome P450 can cause drug interaction. The importance of quality of life is a major factor with regard to management of therapy. Finally, to date, there is no recommendation of systematic a priori dose reduction in the elderly. In this review we describe the various possibilities of treatment for localized RCC or metastatic RCC in an aging population.
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Affiliation(s)
- Amandine Quivy
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
- University of Bordeaux 2 (Victor Ségalen), Bordeaux, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Asma Harbaoui
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Sophie Duc
- University of Bordeaux 2 (Victor Ségalen), Bordeaux, France
- Department of Geriatrics, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Christophe Bernhard
- University of Bordeaux 2 (Victor Ségalen), Bordeaux, France
- Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
- University of Bordeaux 2 (Victor Ségalen), Bordeaux, France
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7
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[Renal function in the elderly after radical tumor nephrectomy and partial nephrectomy]. Urologe A 2012; 51:1375-80. [PMID: 23053032 DOI: 10.1007/s00120-012-2919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Due to rising life-expectancy and increasing use of tomography more elderly patients with incidental renal tumors are being diagnosed. The current article gives an overview of kidney function after renal surgery in the elderly and the aim is to give assistance in clinical practice for deciding how to adequately treat these patients.
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[Coping with small renal tumors in the elderly]. Urologe A 2012; 51:1381-5. [PMID: 23053033 DOI: 10.1007/s00120-012-2921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
With the continually increasing number of elderly patients and the widely distributed use of radiological imaging techniques, the number of elderly patients with incidentally discovered asymptomatic small renal tumors will increase further. Treatment options range from active surveillance, minimally invasive (ablative) techniques, to open or laparoscopic surgery including radical nephrectomy. Many studies have been published on the operative treatment of small renal tumors in the elderly; however, all are limited by the retrospective nature and the small number of cases. Chronological age per se should not be a deciding factor or even an exclusion criterion for treatment of small renal tumors. The decision for therapy should be based on the physical state (comorbidities), mental and emotional state of the patient as well as the individual psychosocial environment. The decision for surgery should be based on organ preservation, depending on the tumor size of ˂7 cm and location, whenever possible.
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Berger J, Fardoun T, Brassart E, Capon G, Bigot P, Bernhard JC, Rigaud J, Patard JJ, Descazeaud A. Detailed Analysis of Morbidity Following Nephrectomy for Renal Cell Carcinoma in Octogenarians. J Urol 2012; 188:736-40. [DOI: 10.1016/j.juro.2012.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Julien Berger
- Department of Urology, Dupuytren University Hospital, Limoges, France
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Abouassaly R, Alibhai SMH, Tomlinson GA, Urbach DR, Finelli A. The effect of age on the morbidity of kidney surgery. J Urol 2011; 186:811-6. [PMID: 21788042 DOI: 10.1016/j.juro.2011.04.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Previous reports of the morbidity of renal surgery have been primarily from academic tertiary referral centers and, thus, they may not reflect general clinical practice. We determined the effect of age and comorbidity on in-hospital surgical morbidity for radical and partial nephrectomy on a population level. MATERIALS AND METHODS Data were obtained from a Canadian national discharge abstract database. From April 1998 to March 2008 information was available on 20,286 radical and 4,292 partial nephrectomies. Complications were identified using specific ICD-9 and 10 diagnosis and procedure codes. Complication rates were estimated by procedure type and by various explanatory variables, including patient age and Charlson comorbidity score. Multivariate logistic regressions were constructed for radical and partial nephrectomy to determine associations between explanatory variables and complications. RESULTS Overall complications developed in 34.1% of radical and 34.3% of partial nephrectomy cases. Patients were more likely to have cardiac, respiratory, vascular and surgical complications after radical nephrectomy while they were more likely to experience genitourinary and nephrectomy specific complications after partial nephrectomy. On multivariate logistic regression after radical and partial nephrectomy complications increased with age and Charlson score. After adjusting for other covariates patients with a Charlson score of greater than 2 were approximately 6 times more likely to experience a complication than patients with a Charlson score of 0 for radical and partial nephrectomy (OR 6.22, 95% CI 5.18-7.48 and OR 5.68, 95% CI 3.72-8.66, respectively). CONCLUSIONS In our population based study radical nephrectomy and partial nephrectomy were associated with higher morbidity than previously reported, particularly in the elderly population and in patients with comorbidity.
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Affiliation(s)
- Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Roos FC, Thomas C, Hampel C, Thüroff JW. Nephron-sparing surgery versus radical nephrectomy for kidney tumors: benefits and limitations. Expert Rev Anticancer Ther 2011; 11:805-8. [PMID: 21707272 DOI: 10.1586/era.11.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Renal Cell Carcinoma in Octogenarians: Nephron Sparing Surgery Should Remain the Standard of Care. J Urol 2011; 185:415-20. [DOI: 10.1016/j.juro.2010.09.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Indexed: 01/22/2023]
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Roos FC, Brenner W, Jäger W, Albert C, Müller M, Thüroff JW, Hampel C. Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm. BJU Int 2010; 107:554-61. [DOI: 10.1111/j.1464-410x.2010.09516.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magrill D, Yap T, Durrant J, Anderson C, Rimington P, Rane A. Laparoscopic Extirpative Renal Surgery in the Octogenarian Population. J Endourol 2009; 23:1499-502. [DOI: 10.1089/end.2009.0372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dan Magrill
- Department of Urology, St. George's Hospital, London, United Kingdom
| | - Tet Yap
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| | - Jordan Durrant
- Department of Urology, St. George's Hospital, London, United Kingdom
| | | | - Peter Rimington
- Department of Urology, Eastbourne District General Hospital, Eastbourne, United Kingdom
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
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The impact of renal surgery on global renal function and non-oncologic morbidity. Curr Urol Rep 2009; 10:17-22. [DOI: 10.1007/s11934-009-0005-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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