Comorbidities and causes of death in the management of localized T1a kidney cancer

Hiten D. Patel, Max Kates, Phillip Martin Pierorazio, Michael Gorin, Gautam Jayram, Mark W. Ball, Elias S. Hyams, Mohamad E Allaf

Research output: Contribution to journalArticle

Abstract

Objective: The objectives of the present study were analyze specific comorbidities associated with survival and actual causes of death for patients with small renal masses, and to suggest a simplified measure associated with decreased overall survival specific to this population. Methods: The Surveillance, Epidemiology and End Results-Medicare database (1995-2007) was queried to identify patients with localized T1a kidney cancer undergoing partial nephrectomy, radical nephrectomy or deferring therapy. We explored independent associations of specific comorbidities with causes of death, and developed a simplified cardiovascular index. Cox proportional hazards, and Fine and Gray competing risks regression were used. Results: Of 7177 Medicare beneficiaries in the study population, 754 (10.5%) deferred therapy, 1849 (25.8%) underwent partial nephrectomy and 4574 (63.7%) underwent radical nephrectomy with none of the selected comorbidities identified in 3682 (51.3%) patients. Congestive heart failure, chronic kidney disease, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and cerebrovascular disease were associated with decreased overall survival. The cardiovascular index provided good survival risk stratification, and reclassified 1427 (41%) patients with a score ≥1 on the Charlson Comorbidity Index to a 0 on the cardiovascular index with minimal concession of 5-year survival. Conclusions: Congestive heart failure, chronic kidney disease, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and cerebrovascular disease were associated with decreased overall survival among Medicare beneficiaries with small renal masses. The cardiovascular index could serve as a clinically useful prognostic aid when advising older patients that are borderline candidates for surgery or active surveillance.

Original languageEnglish (US)
Pages (from-to)1086-1092
Number of pages7
JournalInternational Journal of Urology
Volume21
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Kidney Neoplasms
Comorbidity
Cause of Death
Nephrectomy
Survival
Medicare
Cerebrovascular Disorders
Peripheral Vascular Diseases
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Heart Failure
Kidney
Population
Epidemiology
Databases
Therapeutics

Keywords

  • Active surveillance
  • Comorbidity
  • Epidemiology and End Results-Medicare
  • Kidney cancer
  • Renal cell carcinoma
  • Surveillance

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Comorbidities and causes of death in the management of localized T1a kidney cancer. / Patel, Hiten D.; Kates, Max; Pierorazio, Phillip Martin; Gorin, Michael; Jayram, Gautam; Ball, Mark W.; Hyams, Elias S.; Allaf, Mohamad E.

In: International Journal of Urology, Vol. 21, No. 11, 01.11.2014, p. 1086-1092.

Research output: Contribution to journalArticle

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AU - Jayram, Gautam

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AU - Hyams, Elias S.

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