Korean J Urol.  2014 Jul;55(7):446-452. 10.4111/kju.2014.55.7.446.

The Type of Nephrectomy Has Little Effect on Overall Survival or Cardiac Events in Patients of 70 Years and Older With Localized Clinical T1 Stage Renal Masses

• Kyung YS
• You D
• Kwon T
• Song SH
• Jeong IG
• Song C
• Hong B
• Hong JH
• Ahn H
• Kim CS

• KMID: 1794572
• DOI: http://doi.org/10.4111/kju.2014.55.7.446

Abstract

PURPOSE
To compare the outcomes of nephron-sparing options (e.g., partial nephrectomy [PN]) and low-surgical-morbidity options (e.g., radical nephrectomy [RN]) in elderly patients with limited life expectancy.
MATERIALS AND METHODS
We retrospectively reviewed 135 patients aged 70 years or older who underwent RN (n=82) or PN (n=53) for clinical T1 stage renal masses between January 2000 and December 2012. Clinicopathologic data were thoroughly analyzed and compared between the RN and PN groups. The modification of diet in renal disease equation was used to estimate glomerular filtration. Overall survival and cardiac events were assessed by using Kaplan-Meier survival analysis and Cox proportional-hazards regression modeling.
RESULTS
Over a median follow-up period of 59.72 months, 17 patients (20.7%) in the RN group and 3 patients (5.7%) in the PN group died. Chronic kidney disease (<60 mL/min/1.73 m2) developed more frequently in RN patients than in PN patients (75.6% vs. 41.5%, p<0.001). The 5-year overall survival rate did not differ significantly between the RN and PN groups (90.7% vs. 93.8%; p=0.158). According to the multivariate analysis, the Charlson comorbidity index score was an independent predictor of overall survival (hazard ratio [HR], 2.679, p=0.037). Type of nephrectomy was not significantly associated with overall survival (HR, 2.447; p=0.167) or cardiac events (HR, 1.147; p=0.718).
CONCLUSIONS
Although chronic kidney disease was lower after PN, overall survival and cardiac events were similar regardless of type of nephrectomy.

Keyword

Aged; Cardiovascular diseases; Kidney; Mortality; Nephrectomy

MeSH Terms

Age Factors
Aged
Cardiovascular Diseases/*etiology
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Neoplasms/pathology/*surgery
Male
Neoplasm Staging
Nephrectomy/*adverse effects/*methods
Renal Insufficiency, Chronic/complications
Retrospective Studies

Figure

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  FIG. 1 Kaplan-Meier survival curves comparing radical nephrectomy vs. partial nephrectomy. (A) Overall survival, (B) cardiac events.

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