In a nationally representative sample of patients with T1a kidney cancer, the majority of those with a life expectancy of less than 10 years as well as a significant minority of those with life expectancy of less than 5 years were treated with surgery or ablation, according to a study published in The Journal of Urology.1
Researchers led by Timothy Daskivich, MD, MSHPM, sampled 9825 patients who were over 65 years of age and diagnosed with clinical T1a kidney cancer from 2000 to 2010 through the SEER-Medicare database. They used competing risks regression in order to model survival by age and comorbidity as well as identify patients with life expectancy of less than 10 and 5 years.
They found that life expectancy was less than 10 years for patients with Charleston scores 3+ and aged 66 to 80, Charleston scores 1+ for those aged 80 to 84, and all patients 85 years and older.
Among the patients with life expectancy of less than 10 years, multivariate probabilities of aggressive treatment were 85% for patients aged 66 to 69, 84% for 70 to 74, 82% for 75 to 79, 75% for 80 to 84, and 50% for patients at least 85 years of age. For those treated aggressively within this group, treatment choice was mostly radical nephrectomy and less often partial nephrectomy or ablation.
In patients with a life expectancy of less than 5 years, multivariate probability of aggressive treatment was 41%, with more patients choosing surgery than ablation.
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“Life expectancy should be better incorporated into treatment decision making for early-stage kidney cancer,” the authors concluded.
- Daskivich TJ, Tan H, Litwin MS, et al. Life expectancy and variation in treatment for early-stage kidney cancer. [published online ahead of print March 21, 2016]. The Journal of Urology. doi: http://dx.doi.org/10.1016/j.juro.2016.03.133