Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)
Maria Mir
,
Nicola Pavan
,
Umberto Capitanio
(1)
,
Alessandro Antonelli
,
Ithaar Derweesh
,
Oscar Rodriguez-Faba
,
Estefania Linares
,
Toshio Takagi
,
Koon Rha
,
Christian Fiori
,
Tobias Maurer
,
Chao Zang
,
Alexandre Mottrie
(2)
,
Paolo Umari
,
Alexandre Long
,
Gaelle Fiard
(3)
,
Cosimo de Nunzio
(4)
,
Andrea Tubaro
(5)
,
Andrew Tracey
,
Matteo Ferro
,
Ottavio de Cobelli
,
Salvatore Micali
,
Luigi Bevilacqua
,
João Torres
,
Luigi Schips
(6)
,
Roberto Castellucci
,
Ryan Dobbs
,
Giuseppe Quarto
,
Pierluigi Bove
,
Antonio Celia
,
Bernardino de Concilio
,
Carlo Trombetta
,
Tommaso Silvestri
,
Alessandro Larcher
(7)
,
Francesco Montorsi
(1)
,
Carlo Palumbo
,
Maria Furlan
,
Ahmet Bindayi
,
Zachary Hamilton
,
Alberto Breda
,
Joan Palou
(8)
,
Alfredo Aguilera
(9)
,
Kazunari Tanabe
,
Ali Raheem
,
Thomas Amiel
,
Bo Yang
(10)
,
Estevão Lima
,
Simone Crivellaro
,
Sisto Perdonà
(11)
,
Caterina Gregorio
,
Giulia Barbati
,
Francesco Porpiglia
,
Riccardo Autorino
1
Department of urology
2 OLVG Hospital
3 TIMC-IMAG-GMCAO - Gestes Medico-chirurgicaux Assistés par Ordinateur
4 Department of Urology
5 Department of Clinical and Molecular Medicine
6 Department of Urology
7 Cancer Prognostics and Health Outcomes Unit
8 servicio de urologia
9 La Paz University Hospital
10 IIE - Institute of Information Engineering [Beijing]
11 Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section
2 OLVG Hospital
3 TIMC-IMAG-GMCAO - Gestes Medico-chirurgicaux Assistés par Ordinateur
4 Department of Urology
5 Department of Clinical and Molecular Medicine
6 Department of Urology
7 Cancer Prognostics and Health Outcomes Unit
8 servicio de urologia
9 La Paz University Hospital
10 IIE - Institute of Information Engineering [Beijing]
11 Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section
Maria Mir
- Fonction : Auteur
Nicola Pavan
- Fonction : Auteur
Alessandro Antonelli
- Fonction : Auteur
Ithaar Derweesh
- Fonction : Auteur
Oscar Rodriguez-Faba
- Fonction : Auteur
Estefania Linares
- Fonction : Auteur
Toshio Takagi
- Fonction : Auteur
Koon Rha
- Fonction : Auteur
Christian Fiori
- Fonction : Auteur
Tobias Maurer
- Fonction : Auteur
Chao Zang
- Fonction : Auteur
Paolo Umari
- Fonction : Auteur
Alexandre Long
- Fonction : Auteur
Andrew Tracey
- Fonction : Auteur
Matteo Ferro
- Fonction : Auteur
Ottavio de Cobelli
- Fonction : Auteur
Salvatore Micali
- Fonction : Auteur
Luigi Bevilacqua
- Fonction : Auteur
João Torres
- Fonction : Auteur
Roberto Castellucci
- Fonction : Auteur
Ryan Dobbs
- Fonction : Auteur
Giuseppe Quarto
- Fonction : Auteur
Pierluigi Bove
- Fonction : Auteur
Antonio Celia
- Fonction : Auteur
Bernardino de Concilio
- Fonction : Auteur
Carlo Trombetta
- Fonction : Auteur
Tommaso Silvestri
- Fonction : Auteur
Carlo Palumbo
- Fonction : Auteur
Maria Furlan
- Fonction : Auteur
Ahmet Bindayi
- Fonction : Auteur
Zachary Hamilton
- Fonction : Auteur
Alberto Breda
- Fonction : Auteur
Kazunari Tanabe
- Fonction : Auteur
Ali Raheem
- Fonction : Auteur
Thomas Amiel
- Fonction : Auteur
Estevão Lima
- Fonction : Auteur
Simone Crivellaro
- Fonction : Auteur
Caterina Gregorio
- Fonction : Auteur
Giulia Barbati
- Fonction : Auteur
Francesco Porpiglia
- Fonction : Auteur
Riccardo Autorino
- Fonction : Auteur
Résumé
PURPOSE:
To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.
PATIENTS AND METHODS:
A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).
RESULTS:
A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13-63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis.
CONCLUSIONS:
Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.