title: Overall survival and renal function after partial and radical nephrectomy among older patients with localised renal cell carcinoma: a propensity-matched multicentre study.
abstract: BACKGROUND
  This study aimed to evaluate the overall survival (OS) rate and renal function after radical nephrectomy (RN) and partial nephrectomy (PN) in patients aged ⩾65years.
  
  
  METHODS
  Patients who underwent RN (n=622) or PN (n=622) for renal cell carcinoma (pT1N0M0) between 1999 and 2011 were propensity-score matched in our multicentre database. To investigate the relative effect of PN on OS according to age, we divided the patients into two age subgroups (<65 and ⩾65years). The 5-year OS rates and probabilities of freedom from chronic kidney disease (CKD III or IV) were estimated using the Kaplan-Meier method and separate Cox proportional hazards models.
  
  
  RESULTS
  The 5-year OS rates after surgery were 94.7% for PN and 91.9% for RN in the older patients (P=0.698). The corresponding rates in the younger patients were 99.7% for PN and 96.3% for RN (P=0.015). In separate Cox hazards models for OS, the older patients who underwent PN were not significantly different from their RN-treated counterparts (hazard ratio (HR): 0.960; 95% confidence interval (CI): 0.277-2.321, P=0.797). Kidney function was significantly better preserved after PN than after RN at all ages. However, stage IV CKD in the older patients did not occur more frequently in the RN arm than in the PN arm.
  
  
  CONCLUSIONS
  Although PN was associated with improved renal function compared with RN, it did not confer a benefit of higher survival rate in elderly patients (⩾65yearsold).
authors.affiliation: Department of Urology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Chung
authors.affiliation: Department of Biostatistics, Yonsei University, Seoul, Republic of Korea.
authors.forename: Nak Hoon
authors.initials: NH
authors.lastname: Son
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Sung Hoo
authors.initials: SH
authors.lastname: Hong
authors.affiliation: Department of Urology, Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Yong June
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea.
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: ssbyun@snubh.org.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D057216:Propensity Score; D016016:Proportional Hazards Models
keywords: Nephrectomy; Propensity score; Renal cell carcinoma; Renal insufficiency; Survival