Kidney Cancer Death Risk Higher with NSM in Older Patients

Nonsurgical management (NSM) of early-stage kidney cancer is associated with an increased risk of death from the cancer among patients aged 75-79 years compared with surgical treatment, researchers reported.

Hiten D. Patel, MD, MPH, of the James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, and colleagues studied 7,177 Medicare beneficiaries aged 65 and older diagnosed with localized T1a kidney cancer. Of these, 754 (10.5%) underwent NSM, 1,849 (25.8%) underwent partial nephrectomy (PN), and 4,574 (63.7%) underwent radical nephrectomy (RN).

At a median follow-up of 56 months, 436 NSM patients (57.8%), 389 PN patients (21%), and 1,598 RN patients (34.9%) died. PN and RN were associated with a 60% and 50% decreased risk of all-cause mortality and a 58% and 38% decreased risk of cancer-specific mortality compared with NSM, the researchers reported online ahead of print in Urology. Among patients younger than 75, results showed no difference in cancer-specific survival between any two treatment groups, “indicating that these patients are well selected for treatment,” the authors stated. Among patients aged 75-79, PN and RN were associated with a significant 73% and 60% decreased risk of cancer-related mortality compared with NSM. Among patients aged 80 and older, PN was associated with a significant 59% decreased risk of cancer-related death. RN was associated with a nonsignificant 32% decreased risk.

Dr. Patel's group noted that it is important to consider the influence of confounding by indication. “The best candidates for NSM might be older individuals with multiple comorbidities, which imposes an inherent bias for comparative effectiveness as these patients experience significant all-cause mortality,” they wrote. “However, these competing risks of death might be necessary to reduce the proportion of deaths because of kidney cancer.”

They also noted: “Improved risk-stratification might be needed for patients aged 75 years or older, as a significant proportion might still die of kidney cancer.”

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