title: Prediction of Competing Mortality for Decision-making Between Surgery or Observation in Elderly Patients With T1 Kidney Cancer.
abstract: To predict the risk of cancer-specific mortality (CSM) or other-cause mortality (OCM) for T1 kidney cancer patients, aiming at identifying those who would benefit from surgery over observation.
  
  
  
  Overall, 11,192 T1 kidney cancer patients treated with surgery or observation in the Surveillance, Epidemiology, and End Results-Medicare database were assessed. A competing risk regression (CRR) model was fitted to predict CSM and OCM after surgery or observation. Covariates consisted of age, gender, race, Charlson comorbidity index (CCI), history of acute kidney injury or chronic kidney disease, tumor size, and year of diagnosis.
  
  
  
  At a median follow-up of 64 months, the 5-year rates of CSM and OCM were 6.7% and 24%, respectively. At CRR predicting CSM, surgery (hazard ratio [HR] 0.46; P < .0001) and year of diagnosis (HR 0.96; P < .0001) were associated with lower CSM risk. Conversely, age (HR 1.05; P < .0001), CCI (HR 1.07; P < .0001), and tumor size (HR 1.03; P < .0001) were associated with higher CSM risk. At CRR predicting OCM, surgery (HR 0.66; P < .0001), female gender (HR 0.83; P < .0001), Other race (HR 0.82; P < .0001), and year of diagnosis (HR 0.95; P < .0001) were associated with lower OCM risk. Conversely, age (HR 1.06; P < .0001), African American race (HR 1.16; P < .01), CCI (HR 1.17; P < .0001), and acute kidney injury or chronic kidney disease (HR 1.35; P < .0001) were associated with higher OCM risk.
  
  
  
  The benefit of surgery over observation was more pronounced in younger and healthier patients with larger tumors. The proposed model can aid in clinical decision-making, providing crucial information on CSM and OCM risk after either treatment modality.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: alelarcher@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D057832:Watchful Waiting