Survival after diagnosis of localized T1a kidney cancer

Current population-based practice of surgery and nonsurgical management

Hiten D. Patel, Max Kates, Phillip Martin Pierorazio, Elias S. Hyams, Michael Gorin, Mark W. Ball, Sam B. Bhayani, Xuan Hui, Carol Thompson, Mohamad E Allaf

Research output: Contribution to journalArticle

Abstract

Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results-Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5%) underwent NSM, 1849 (25.8%) PN, and 4574 (63.7%) RN, with 436 (57.8%), 389 (21.0%), and 1598 (34.9%) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95% CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95% CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients (

Original languageEnglish (US)
Pages (from-to)126-132
Number of pages7
JournalUrology
Volume83
Issue number1
DOIs
StatePublished - Jan 2014

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Kidney Neoplasms
Nephrectomy
Survival
Population
Medicare
Neoplasms
Safety Management
Propensity Score
Epidemiology
Databases

ASJC Scopus subject areas

  • Urology

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Survival after diagnosis of localized T1a kidney cancer : Current population-based practice of surgery and nonsurgical management. / Patel, Hiten D.; Kates, Max; Pierorazio, Phillip Martin; Hyams, Elias S.; Gorin, Michael; Ball, Mark W.; Bhayani, Sam B.; Hui, Xuan; Thompson, Carol; Allaf, Mohamad E.

In: Urology, Vol. 83, No. 1, 01.2014, p. 126-132.

Research output: Contribution to journalArticle

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abstract = "Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results-Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5{\%}) underwent NSM, 1849 (25.8{\%}) PN, and 4574 (63.7{\%}) RN, with 436 (57.8{\%}), 389 (21.0{\%}), and 1598 (34.9{\%}) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95{\%} CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95{\%} CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients (",
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N2 - Objective To compare overall and cancer-specific survival (CSS) of patients who undergo nonsurgical management (NSM), partial nephrectomy (PN), and radical nephrectomy (RN). NSM is being increasingly used for older patients with early-stage kidney cancer and competing risks of death. However, survival is poorly characterized for this approach compared with surgery with PN or RN. Methods The Surveillance, Epidemiology and End Results-Medicare database from 1995 to 2007 was used to identify patients aged 65 years or older diagnosed with localized T1a kidney cancer treated with PN, RN, or NSM. We used Cox proportional hazards regression, Fine and Gray competing risks regression, and propensity score matching to adjust for patient and tumor characteristics. Results Of 7177 Medicare beneficiaries meeting the inclusion criteria, 754 (10.5%) underwent NSM, 1849 (25.8%) PN, and 4574 (63.7%) RN, with 436 (57.8%), 389 (21.0%), and 1598 (34.9%) patients dying from any cause, respectively, at a median follow-up of 56 months. Overall survival favored PN and RN compared with NSM (hazard ratio [95% CI]: 0.40 [0.34-0.46] and 0.50 [0.45-0.56], respectively) as did CSS (hazard ratio [95% CI]: 0.42 [0.27-0.64] and 0.62 [0.46-0.85], respectively). However, there was no difference in CSS between any 2 treatment groups for younger patients (

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