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. 2020 Mar 20:15:431-439.
doi: 10.2147/CIA.S243902. eCollection 2020.

The Effect of Cytoreductive Partial Nephrectomy in Elderly Patients with Metastatic Renal Cell Carcinoma

Jiabi Chen  1 , Qingliu He  1 , Weihui Liu  1 , Yining Li  1 , Wei Zhuang  1
Affiliations

The Effect of Cytoreductive Partial Nephrectomy in Elderly Patients with Metastatic Renal Cell Carcinoma

Jiabi Chen et al. Clin Interv Aging. .

Abstract

Objective: 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.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of overall survival for elderly metastatic renal cell carcinoma according to cytoreductive nephrectomy (A), partial nephrectomy and radical nephrectomy (B, C).
Figure 2
Figure 2
Survival comparison of patients undergoing cytoreductive nephrectomy according to tumor size ≤7cm (A), isolated metastasis (B) and N0 stage (C) and N1 stage (D).
Figure 3
Figure 3
Risk analysis of patients undergoing cytoreductive partial nephrectomy according to tumor diameter >7cm (A) and N1 stage (B).
Figure 4
Figure 4
Nomogram model (A) for elderly metastatic renal cell carcinoma and calibration curve of survival probability prediction: 1-year (B), 2-year (C), 3-year (D).
See this image and copyright information in PMC

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