Treatment Modalities and Risks of Complication for Patients With Localized Renal Cell Carcinoma Aged 75 and Older.

Autor: Suk-Ouichai C; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Patel HD; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Sato KT; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Kundu SD; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Ross AE; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Perry KT Jr; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Oct 29. Date of Electronic Publication: 2024 Oct 29.
DOI: 10.1002/jso.27962
Abstrakt: Background and Objectives: Partial (PN)/radical (RN) nephrectomy is the standard treatment for localized renal-cell carcinoma (RCC). The potential risks of these procedures are concerns for the elderly. We evaluated perioperative outcomes/survival for patients aged ≥ 75 years with localized RCC who underwent PN, RN, or thermal ablation (TA).
Methods: Localized RCC patients undergoing PN/RN/TA (2000-2023) were retrospectively reviewed. Logistic-regression assessed factors associated with major complications. Kaplan-Meier estimated survival.
Results: A total of 278 patients (≥ 75 years) with RCC who received intervention (107RN, 101PN, and 70TA) were identified. Median age was 78 years. PN patients were younger than other cohorts (77 vs. 79, p = 0.006). Patients with cancer comorbidities underwent TA than PN/RN (93% vs. 88%/76%, respectively). Median tumor size was 4.0, 3.0, and 2.6 cm in RN, PN, and TA cohorts, respectively. RN patients had more complex masses compared to other cohorts (9 vs. 7, p < 0.001). Postoperative complications were significantly greater among PN patients (p = 0.03), but there was no significant difference in Clavien ≥ 3 complications. Peripheral vascular disease (PVD) was associated with Clavien ≥ 3 complications on multivariable analysis (p = 0.03). RN was performed at a stable rate while PN decreased in favor of TA. There was no significant difference in RCC-/non-RCC-specific survival among treatment modalities.
Conclusions: It is important to make informed decisions about treating RCC in the elderly to reduce morbidity/mortality. PVD could be a determining factor favoring TA for amenable tumors.
(© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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