title: Comparison of partial vs radical nephrectomy with regard to other-cause mortality in T1 renal cell carcinoma among patients aged ≥75 years with multiple comorbidities.
abstract: OBJECTIVE
  To quantify the effect of partial nephrectomy (PN) vs radical nephrectomy (RN) on other-cause mortality (OCM) in elderly patients with localized renal cell carcinoma (RCC) and/or multiple comorbidities.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results Medicare-linked database, patients with T1 RCC, aged ≥75 years, or who had ≥2 comorbidities, were identified (1988-2005). To adjust for inherent differences between treatment types, propensity-based matched analyses were performed. Competing-risks regression analyses for prediction of OCM were assessed according to treatment type. The effect of PN and RN on OCM was examined in three sub-groups: patients aged ≥75 years; patients with ≥2 comorbidities; and patients aged ≥75 years with ≥2 comorbidities.
  
  
  RESULTS
  After propensity-based matched analyses and adjustment for all covariates, PN was found to exert a protective effect relative to RN with respect to OCM in all patients (hazard ratio [HR]: 0.84, P = 0.048). In subanalyses, no difference was recorded between PN and RN in patients who were aged ≥75 years (HR: 0.83, P = 0.2), with ≥2 baseline comorbidities at diagnosis (HR: 0.83, P = 0.1), or in patients who were aged ≥75 years and who had ≥2 baseline comorbidities (HR: 0.77, P = 0.2).
  
  
  CONCLUSIONS
  Some elderly patients and/or those with multiple comorbidities at diagnosis may not benefit from PN with respect to OCM. After rigorous patient selection, alternative treatment options could be considered.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada. mcw.sun@umontreal.ca
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Nawar
authors.initials: N
authors.lastname: Hanna
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology