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Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

  • Maria C. Mir
  • Nicola Pavan
  • Umberto Capitanio
  • Alessandro Antonelli
  • Ithaar Derweesh
  • Oscar Rodriguez-Faba
  • Estefania Linares
  • Toshio Takagi
  • Koon H. Rha
  • Christian Fiori
  • Tobias Maurer
  • Chao Zang
  • Alexandre Mottrie
  • Paolo Umari
  • Jean-Alexandre Long
  • Gaelle Fiard
  • Cosimo De Nunzio
  • Andrea Tubaro
  • Andrew T. Tracey
  • Matteo Ferro
  • Ottavio De Cobelli
  • Salvatore Micali
  • Luigi Bevilacqua
  • João Torres
  • Luigi Schips
  • Roberto Castellucci
  • Ryan Dobbs
  • Giuseppe Quarto
  • Pierluigi Bove
  • Antonio Celia
  • Bernardino De Concilio
  • Carlo Trombetta
  • Tommaso Silvestri
  • Alessandro Larcher
  • Francesco Montorsi
  • Carlotta Palumbo
  • Maria Furlan
  • Ahmet Bindayi
  • Zachary Hamilton
  • Alberto Breda
  • Joan Palou
  • Alfredo Aguilera
  • Kazunari Tanabe
  • Ali Raheem
  • Thomas Amiel
  • Bo Yang
  • Estevão Lima
  • Simone Crivellaro
  • Sisto Perdona
  • Caterina Gregorio
  • Giulia Barbati
  • Francesco Porpiglia
  • Riccardo AutorinoEmail author
Original Article
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Abstract

Purpose

To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.

Patients and methods

A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).

Results

A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13–63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p < 0.01). PN was not correlated with OM (HR = 0.71; p = 0.56), OCM (HR = 0.74; p = 0.5), and showed a protective trend for CSM (HR = 0.19; p = 0.05). PN was found to be a protective factor for surgical CKD (HR = 0.28; p < 0.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis.

Conclusions

Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined.

Keywords

Kidney cancer Elderly Nephrectomy Partial nephrectomy 

Notes

Author contributions

Protocol/project development: MCM, NP, UC, AA, ID, FP, and RA. Data collection or management: MCM, NP, OR-F, EL, TT, CF, CZ, PU, GF, CDN, ATT, MF, LB, JT, RC, RD, BDC, TS, AL, CP, MF, AB, ZH, AB, AR, and TA. Data analysis: GB, CG, MCM, and AC. Manuscript writing: RA, MCM, NP. Manuscript editing: UC, AA, ID, KHR, TM, CZ, AM, J-AL, AT, ODC, SM, LS, PB, AC, CT, FM, AB, JP, AA, KT, BY, EL, SC, SP, and ID.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Research involving human participants

The RESURGE database is an IRB approved study at participating Centers.

Informed consent

Patients included in this retrospective analysis had signed an informed consent at the time of the surgery.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maria C. Mir
    • 1
  • Nicola Pavan
    • 2
  • Umberto Capitanio
    • 3
  • Alessandro Antonelli
    • 4
  • Ithaar Derweesh
    • 5
  • Oscar Rodriguez-Faba
    • 6
  • Estefania Linares
    • 7
  • Toshio Takagi
    • 8
  • Koon H. Rha
    • 9
  • Christian Fiori
    • 10
  • Tobias Maurer
    • 11
  • Chao Zang
    • 12
  • Alexandre Mottrie
    • 13
    • 14
  • Paolo Umari
    • 13
    • 14
  • Jean-Alexandre Long
    • 15
  • Gaelle Fiard
    • 15
  • Cosimo De Nunzio
    • 16
  • Andrea Tubaro
    • 16
  • Andrew T. Tracey
    • 17
  • Matteo Ferro
    • 18
  • Ottavio De Cobelli
    • 18
  • Salvatore Micali
    • 19
  • Luigi Bevilacqua
    • 19
  • João Torres
    • 20
  • Luigi Schips
    • 21
  • Roberto Castellucci
    • 21
  • Ryan Dobbs
    • 22
  • Giuseppe Quarto
    • 23
  • Pierluigi Bove
    • 24
  • Antonio Celia
    • 25
  • Bernardino De Concilio
    • 25
  • Carlo Trombetta
    • 2
  • Tommaso Silvestri
    • 2
  • Alessandro Larcher
    • 3
  • Francesco Montorsi
    • 3
  • Carlotta Palumbo
    • 4
  • Maria Furlan
    • 4
  • Ahmet Bindayi
    • 5
  • Zachary Hamilton
    • 5
  • Alberto Breda
    • 6
  • Joan Palou
    • 6
  • Alfredo Aguilera
    • 7
  • Kazunari Tanabe
    • 8
  • Ali Raheem
    • 9
  • Thomas Amiel
    • 11
  • Bo Yang
    • 12
  • Estevão Lima
    • 20
  • Simone Crivellaro
    • 22
  • Sisto Perdona
    • 23
  • Caterina Gregorio
    • 26
  • Giulia Barbati
    • 27
  • Francesco Porpiglia
    • 10
  • Riccardo Autorino
    • 17
    Email author
  1. 1.Department of UrologyFundacion Instituto Valenciano OncologiaValenciaSpain
  2. 2.Urology Clinic, Department of Medical, Surgical and Health ScienceUniversity of TriesteTriesteItaly
  3. 3.Unit of Urology, Division of Oncology, Urological Research InstituteIRCCS Ospedale San RaffaeleMilanItaly
  4. 4.Department of Urology, Spedali Civili HospitalUniversity of BresciaBresciaItaly
  5. 5.Department of UrologyUCSDSan DiegoUSA
  6. 6.Department of Urology, Fundació PuigvertAutonoma University of BarcelonaBarcelonaSpain
  7. 7.Department of UrologyHospital Universitario La PazMadridSpain
  8. 8.Department of Urology, Kidney CenterTokyo Women’s Medical UniversityTokyoJapan
  9. 9.Department of Urology, Urological Science InstituteYonsei University College of MedicineSeoulKorea
  10. 10.Department of Urology, School of MedicineUniversity of Turin-San Luigi Gonzaga HospitalTurinItaly
  11. 11.Department of UrologyTechnical University of MunichMunichGermany
  12. 12.Department of UrologyChanghai HospitalShangahaiChina
  13. 13.ORSI AcademyMelleBelgium
  14. 14.Department of UrologyOnzeLieve Vrouw HospitalAalstBelgium
  15. 15.Department of UrologyUniversity of GrenobleGrenobleFrance
  16. 16.Department of UrologySant’Andrea Hospital, University La SapienzaRomeItaly
  17. 17.Division of UrologyVCU HealthRichmondUSA
  18. 18.Department of UrologyEuropean Oncology InstituteMilanItaly
  19. 19.Department of UrologyUniversity of Modena and Reggio EmiliaModenaItaly
  20. 20.CUF Urology and University of MinhoBragaPortugal
  21. 21.Division of UrologyASLChietiItaly
  22. 22.Urology, UCIChicagoUSA
  23. 23.Division of UrologyIRCCS Pascale FoundationNaplesItaly
  24. 24.Department of UrologyTor Vergata UniversityRomeItaly
  25. 25.Department of UrologySan Bassiano HospitalBassano del GrappaItaly
  26. 26.Department of Statistical SciencesUniversity of PadovaPaduaItaly
  27. 27.Biostatistics Unit, Department of Medical SciencesUniversity of TriesteTriesteItaly

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