PARTIAL NEPRECTOMY BETTER OPTION FOR SMALL KIDNEY CANCER

NEW YORK (Reuters Health) Jan 19 - Nephron-sparing surgery is linked to better survival than radical nephrectomy for renal cell carcinoma, even among patients over age 80, study findings show.

As reported in the February Journal of Urology published online December 17th, patients in this oldest age group are more than twice as likely to die of the disease during follow-up when their entire kidney is removed than when they undergo partial nephrectomy.

To look at treatment outcomes associated with age, the research team at the Roswell Park Cancer Institute in Buffalo, New York, used the Surveillance, Epidemiology, and End Results (SEER) database to identify nearly 60,000 patients who had surgery for renal cell carcinoma between 1988 and 2005. Of these, 7.5% were age 80 or older; the remainder were between 40-79 years of age. Median follow-up was 27 months and 37 months respectively in the two groups.

The older patients were less likely to have partial nephrectomy in all stage subcategories than their younger peers (overall 8% vs. 13%, p < .001). This was true even for small, organ-confined T1 tumors (11% vs. 20%).

All patients were more likely to undergo total kidney resection as tumor stage advanced.

Although all-cause mortality was higher in the older group (35% vs. 15%, hazard ratio 2.3, p < .001), their cancer-specific death rates were only slightly larger (17% vs. 15%, HR 1.3, p < 0.001).

Octogenarians were 1.3 times more likely to die if they had radical nephrectomy after controlling for gender, stage and grade (p = .004). According to lead author Dr. Nicholas J. Hellenthal and colleagues, "Partial nephrectomy likely helped prevent against the deleterious effects of renal insufficiency, which include cardiovascular complications and other noncancer related causes of death."

The oldest patients were also 2.5 times more likely to die of their cancer following radical surgery (p < .001), most likely because of their more advanced stage disease.

The researchers note that their data didn't include information on comorbidities, performance status, or use of adjuvant therapies, which could have altered their analyses.

Still, they conclude, "These findings potentiate the notion that partial nephrectomy should be used whenever feasible regardless of patient age."

J Urol. 2011;185:415-420. Abstract