Renal cell carcinoma in octogenarians: nephron sparing surgery should remain the standard of care

Data regarding clinical outcomes in elderly patients with renal cell carcinoma are scarce. We determined management, and overall and cancer specific survival in elderly patients with renal cell carcinoma.

Using the Surveillance, Epidemiology, and End Results database we identified 59,944 patients who underwent partial or radical nephrectomy for renal cell carcinoma between 1988 and 2005. Patients were separated into 2 groups of those younger than 80 years, and those 80 years old or older, and were stratified by clinical variables. Chi-square, multivariate logistic regression and Kaplan-Meier analyses were used to determine differences between the cohorts in terms of surgical approach, and overall and cancer specific survival.

In total, 4,227 patients (7.5%) were older than 80 years old. Younger patients more likely underwent partial nephrectomy than their older counterparts (13% vs 8%, p <0.001). At a median followup of 37 months (range 0 to 215) for patients younger than 80 years, and 27 months (range 0 to 203) for octogenarians, older patients were 2.32 times more likely to die (95% CI 2.22-2.42, p <0.001) and 1.33 times more likely to die of renal cell carcinoma (95% CI 1.23-1.43, p <0.001) than their younger counterparts. Older patients who underwent radical nephrectomy were 2.54 times more likely to die of renal cell carcinoma (95% CI 1.68-3.84, p <0.001) than older patients who underwent partial nephrectomy.

Older patients are less likely to undergo partial nephrectomy than their younger counterparts. Octogenarians treated with partial nephrectomy are less likely to die of renal cell carcinoma than those who undergo radical nephrectomy.