title: Life Expectancy and Variation in Treatment for Early Stage Kidney Cancer.
abstract: OBJECTIVE
  Patients with limited life expectancy are at risk for overtreatment of T1a kidney cancer. We sought to determine patterns of treatment for T1a kidney cancer in a nationally representative sample of patients with life expectancy less than 10 and less than 5 years.
  
  
  METHODS
  We sampled 9,825 patients older than 65 years with clinical T1a kidney cancer diagnosed between 2000 and 2010 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. We performed competing risks regression to model survival by age/comorbidity and identified patients with life expectancy less than 10 and less than 5 years. Multivariate logistic regression was used to determine the probability of aggressive treatment with surgery or ablation among those with limited life expectancy.
  
  
  RESULTS
  Life expectancy was less than 10 years in patients 66 to 80 years old with a Charlson score of 3+, in those 80 to 84 years old with a Charlson score of 1+ and in all patients 85 years old or older. Among those with life expectancy less than 10 years the multivariate probability of aggressive treatment was 85%, 84%, 82%, 75% and 50% in those 66 to 69, 70 to 74, 75 to 79, 80 to 84 and 85 years old or older, respectively. In those with life expectancy less than 10 years who were treated aggressively treatment was radical nephrectomy in 61%, partial nephrectomy in 24% and ablation in 14%. Among those with life expectancy less than 5 years (age 85 years or greater with a Charlson score of 3+) the multivariate probability of aggressive treatment was 41% and more often surgery than ablation (68% vs 32% of patients).
  
  
  CONCLUSIONS
  The majority of patients with life expectancy less than 10 years and a significant minority with life expectancy less than 5 years were treated with surgery or ablation for T1a kidney cancer. Life expectancy should be better incorporated into treatment decision making for early stage kidney cancer.
authors.affiliation: Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: Timothy.Daskivich@csmc.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.affiliation: Department of Urology, Weill Cornell School of Medicine, Cornell University, New York, New York.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008017:Life Expectancy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: age factors; comorbidity; kidney neoplasms; life expectancy; nephrectomy