title: Renal cell carcinoma in octogenarians: nephron sparing surgery should remain the standard of care.
abstract: OBJECTIVE
  Data regarding clinical outcomes in elderly patients with renal cell carcinoma are scarce. We determined management, and overall and cancer specific survival in elderly patients with renal cell carcinoma.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results database we identified 59,944 patients who underwent partial or radical nephrectomy for renal cell carcinoma between 1988 and 2005. Patients were separated into 2 groups of those younger than 80 years, and those 80 years old or older, and were stratified by clinical variables. Chi-square, multivariate logistic regression and Kaplan-Meier analyses were used to determine differences between the cohorts in terms of surgical approach, and overall and cancer specific survival.
  
  
  RESULTS
  In total, 4,227 patients (7.5%) were older than 80 years old. Younger patients more likely underwent partial nephrectomy than their older counterparts (13% vs 8%, p <0.001). At a median followup of 37 months (range 0 to 215) for patients younger than 80 years, and 27 months (range 0 to 203) for octogenarians, older patients were 2.32 times more likely to die (95% CI 2.22-2.42, p <0.001) and 1.33 times more likely to die of renal cell carcinoma (95% CI 1.23-1.43, p <0.001) than their younger counterparts. Older patients who underwent radical nephrectomy were 2.54 times more likely to die of renal cell carcinoma (95% CI 1.68-3.84, p <0.001) than older patients who underwent partial nephrectomy.
  
  
  CONCLUSIONS
  Older patients are less likely to undergo partial nephrectomy than their younger counterparts. Octogenarians treated with partial nephrectomy are less likely to die of renal cell carcinoma than those who undergo radical nephrectomy.
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. nicholas.hellenthal@roswellpark.org
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Hellenthal
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Mansour
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Hayn
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwaab
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000469:parasitology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality / Q000592:standards; D009399:Nephrons / Q000601:surgery; D009518:New York; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D012042:Registries; D018570:Risk Assessment; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome