Five‐year survival after surgical treatment for kidney cancer

Abstract

BACKGROUND.Kidney cancer's rising incidence is largely attributable to the increased detection of small renal masses. Although surgery rates have paralleled this incidence trend, mortality continues to rise, calling into question the necessity of surgery for all patients with renal masses. Using a population‐based cohort, a competing risk analysis was performed to estimate patient survival after surgery for kidney cancer, as a function of patient age and tumor size at diagnosis.METHODS.With data from the Surveillance, Epidemiology, and End Results Program (1983–2002), a cohort was assembled of 26,618 patients with surgically treated, local‐regional kidney cancer. Patients were sorted into 20 age‐tumor size categories and the numbers of patients that were alive, dead from kidney cancer, and dead from other causes were tabulated. Poisson regression models were fitted to obtain estimates of cancer‐specific and competing‐cause mortality.RESULTS.Age‐specific kidney cancer mortality was stable across all size strata but varied inversely with tumor size. Patients with the smallest tumors enjoyed the lowest cancer‐specific mortality (5% for masses ≤4 cm). Competing‐cause mortality rose with increasing patient age. The estimated 5‐year competing‐cause mortality for elderly subjects (≥70 years) was 28.2% (95% confidence interval [CI]: 25.9%–30.8%), irrespective of tumor size.CONCLUSIONS.Despite surgical therapy, competing‐cause mortality for patients with renal masses rises with increasing patient age. After 5 years, one‐third of elderly patients (≥70 years) will die from other causes, suggesting the need for prospective studies to evaluate the role of active surveillance as an initial therapeutic approach for some small renal masses. Cancer 2007. © 2007 American Cancer Society.

The effect of age on cancer-specific mortality in patients with small renal masses: A population-based analysis

“…Additionally, only one study authored by Komai et al [14], recorded a survival advantage in young patients with T1-T2 RCC stages relative to the older counterparts. Second, Aziz et al [16] relied on the CORONA database, also showed that young patients (<40 yrs) had lower CSM compared to the older counterparts within a cohort of patients with stage T1-4, N0-1, M0-1. Finally, Rampersaud et al [15] confirmed the less aggressive natural history of RCC for patients age<59 yrs relative to those aged ≥60 yrs across all localized and non-localized stages (T1-4, N0-1, M0-1).…”

“…It should also be noted that 3 single institution studies failed to show a statistically significant relationship between age and CSM in patients with RCC. Specifically, Hollingsworth et al [16] reported a lack of statistically significant difference between young and old individuals in regard to CSM considering stages T1-2, N0, M0 RCC. While, Thompson et al [17] and Gillett et al [18] did not observe a significant CSM disadvantage for individuals with older age considering localized (T1-4, N0, M0) and non-localized (any T, N1 or M1) RCC.…”

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease

“…Up to one third of patients older than 70 years who are treated for kidney tumors have been found to die of other causes. 5 Such ''treatment disconnect'' may be due to the potential of surgical treatment by radical nephrectomy (RN) increasing postoperative CKD morbidity, which in turn increases associated competing causes of death.…”

Epidemiologic characteristics of renal cell carcinoma in Brazil

“…Currently, the disease represents approximately 2.0% of all new cases of cancer and over 100.000 deaths worldwide (3). Improvements in imaging diagnosis may have contributed to the rising incidence of RCC over the past three decades, since this rise in incidence is mainly a result of the increasing detection of small tumors (4). However, at least in the United States, both incidence of late-stage RCC and mortality rates due to the disease have also been rising, implying that improvements in the ability to diagnose RCC are being outweighed by the increasing prevalence of some of the risk factors for this tumor (5).…”