title: Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life.
abstract: OBJECTIVE
  To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC) ≥ 80 years of age in comparison with patients between the ages of 60 and 70 years.
  
  
  METHODS
  The data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters.
  
  
  RESULTS
  Significantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P<0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivariable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P<0.001) were detectable in octogenarians (c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P<0.001), but not for CSM. Limitations are based on the retrospective study design.
  
  
  CONCLUSIONS
  Octogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.
authors.affiliation: Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany. Electronic address: matthias.may@klinikum-straubing.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Urology, San Pio da Pietrelcina Hospital, Vasto, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.affiliation: Department of Urology, Università degli Studi di Milano, Fondazione IRCCS Ca׳ Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.affiliation: Department of Urology, Faculty of Health Sciences, University "La Sapienza", Ospedale Sant׳Andrea, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: Department of Urology, Faculty of Health Sciences, University "La Sapienza", Ospedale Sant׳Andrea, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.affiliation: Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania.
authors.forename: Ioman
authors.initials: I
authors.lastname: Coman
authors.affiliation: Department of Urology, Klinikum Dortmund, Dortmund, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Truss
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria; Department of Urology, Klinikum Dortmund, Dortmund, Germany.
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.affiliation: Department of Urology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Wolff
authors.affiliation: Department of Urology, Emergency Hospital Satu Mare, Satu Mare, Romania.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Feciche
authors.affiliation: Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Fenske
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.affiliation: Department of Urology, San Pio da Pietrelcina Hospital, Vasto, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, WA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, WA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Madison
authors.affiliation: Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Sánchez-Chapado
authors.affiliation: Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain.
authors.forename: Maria del Carmen
authors.initials: Mdel C
authors.lastname: Santiago Martin
authors.affiliation: Department of Urology, G. Rummo Hospital, Benevento, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Salzano
authors.affiliation: Department of Urology, G. Rummo Hospital, Benevento, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lotrecchiano
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors.forename: Raphaela
authors.initials: R
authors.lastname: Waidelich
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.affiliation: Department of Urology, General Hospital of Veria, Thessaloniki, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Sountoulides
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cancer-specific mortality; Competing risks regression analysis; Instrumental variable; Nephrectomy; Octogenarians; Renal cell carcinoma