Renal Cell Carcinoma: Treatment Paradigms in Octogenarians

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Significantly fewer patients had radical nephrectomy in 2004 compared with 2015.
Significantly fewer patients had radical nephrectomy in 2004 compared with 2015.

As expected, patients undergoing RN had longer mean hospital stays (5 days) when compared with PN and PAT (4.6 days and 1.3 days, respectively; P < .001). The all-cause mortality rate was highest in the NT group compared with the RN, PAT, and PN groups (59.1% vs 43.9%, 38.6%, and 28.6%, respectively; P < .001); however, there was no statistical difference in the 30- and 90-day mortality rates.

Significantly fewer patients had radical nephrectomy in 2004 compared with 2015 (48.1% vs 35.8%, P < .001) while all other treatment groups became more frequent.

In the younger comparison group, the all-cause mortality rate was still highest in the NT group, at 31.8% compared with the RN, PAT, and PN groups (13.3%, 14.1%, and 5.7%, respectively; P < .001). Similar to the octogenarian group, there were fewer RNs in 2015 (42.1%) when compared with 2004 (63.2%). NT (5.7%) was the least common treatment option in the control group; rate of NT was significantly higher for octogenarians (36%, P < .001).

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Overall, this study highlighted several key points. In both octogenarians and patients aged 70 years or younger, there was an increase in nephron-sparing treatments (PN, PAT) and NT between 2004 and 2015, while RN declined in both groups during the same period. Octogenarians were significantly more likely to be followed conservatively with NT when compared to the younger cohort. Although the rates of NT increased in both groups, it is important to note that these groups had the highest mortality rates.

The study suggests that for an octogenarian diagnosed with RCC, the likelihood that the older individual will receive RN appears to have been declining over the past decade. PN and PAT represent nephron-sparing treatment options, although the decision on which option to choose still lies with the patient. PAT is less invasive, but has been linked to higher rates of local recurrence.4 In comparison, PN is more invasive, is linked to increased perioperative risk, but is associated with lower risk of local progression.

References

  1. US Preventive Services Task Force; et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(23):2564-2575.
  2. Xiong T, Richardson M, Woodroffe R, Halligan S, Morton D, Lilford RJ. Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol. 2005;78(925):22-29.
  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68(1):7-30.
  4. Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271-1279.
  5. Miller C, Raza SJ, Davaro F, May A, Siddiqui S, Hamilton ZA. Trends in the treatment of clinical T1 renal cell carcinoma for octogenarians: analysis of the National Cancer Database [published online December 6, 2018]. J Geriatr Oncol. doi: 10.1016/j.jgo.2018.11.010
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