Overall survival and renal function after partial and radical nephrectomy among older patients with localised renal cell carcinoma: A propensity-matched multicentre study

Abstract

Background: This study aimed to evaluate the overall survival (OS) rate and renal function after radical nephrectomy (RN) and partial nephrectomy (PN) in patients aged >= 65 years. Methods: Patients who underwent RN (n = 622) or PN (n = 622) for renal cell carcinoma (pT1N0M0) between 1999 and 2011 were propensity-score matched in our multicentre database. To investigate the relative effect of PN on OS according to age, we divided the patients into two age subgroups (<65 and >= 65 years). The 5-year OS rates and probabilities of freedom from chronic kidney disease (CKD III or IV) were estimated using the Kaplan-Meier method and separate Cox proportional hazards models. Results: The 5-year OS rates after surgery were 94.7% for PN and 91.9% for RN in the older patients (P = 0.698). The corresponding rates in the younger patients were 99.7% for PN and 96.3% for RN (P = 0.015). In separate Cox hazards models for OS, the older patients who underwent PN were not significantly different from their RN-treated counterparts (hazard ratio (HR): 0.960; 95% confidence interval (CI): 0.277-2.321, P = 0.797). Kidney function was significantly better preserved after PN than after RN at all ages. However, stage IV CKD in the older patients did not occur more frequently in the RN arm than in the PN arm. Conclusions: Although PN was associated with improved renal function compared with RN, it did not confer a benefit of higher survival rate in elderly patients (>= 65 years old). (C) 2014 Elsevier Ltd. All rights reserved.