Clinical Interventions in Aging (Mar 2020)
The Effect of Cytoreductive Partial Nephrectomy in Elderly Patients with Metastatic Renal Cell Carcinoma
Abstract
Jiabi Chen, Qingliu He, Weihui Liu, Yining Li, Wei Zhuang Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of ChinaCorrespondence: Wei ZhuangThe Second Affiliated Hospital of Fujian Medical University, Zhongshan North Road, Licheng District, Quanzhou, Fujian 362000, People’s Republic of ChinaFax +86 59 587365269Email [email protected]: To explore the survival value of cytoreductive partial nephrectomy (cPN) in elderly with metastatic renal cell carcinoma (EmRCC) and evaluate the characteristics of patients who benefit from cPN.Materials and Methods: This was a study including 6105 patients aged ≥ 65 years with metastatic renal cell carcinoma (RCC) queried from Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2015, among which 1264 patients underwent cytoreductive nephrectomy (CN), 78 patients underwent cPN and 1186 patients underwent cytoreductive radical nephrectomy (cRN). Kaplan–Meier (K-M) method and Cox proportional-hazards model (COX) were used to evaluate the survival prognosis. Overall survival (OS) was compared between groups using propensity score matching (PSM) to balance the effects of confounding factors such as general features and pathological features. At last, we constructed a nomogram visualization modelled by R language to predict survival.Results: For patients with EmRCC, especially for male patients with tumors size ≤ 7 cm, N0 stage, or isolated metastases, cPN brought a better survival than cRN. Tumor size and N stage were independent risk factors affecting the survival of cPN patients. cPN for patients with tumor size > 7 cm or N1 stage may present a higher risk of death.Conclusion: The implementation of cPN for patients with EmRCC who meet specific clinical characteristics such as tumors size ≤ 7 cm, N0 stage, or isolated metastases seems to help improve the survival prognosis.Keywords: elderly, metastatic renal cell carcinoma, partial nephrectomy, radical nephrectomy, survival
