Hellenthal Nicholas J, Chamie Karim, Ramirez Michelle L, deVere White Ralph W
Department of Urology, University of California Davis Medical Center, Sacramento, California, USA.
J Urol. 2009 Mar;181(3):1013-8; discussion 1018-9. doi: 10.1016/j.juro.2008.10.159. Epub 2009 Jan 16.
Studies suggest that radical nephrectomy imparts a survival benefit in select patients with metastatic renal cell carcinoma. We determined the roles of patient age, gender, race and in particular marital status in the decision to pursue nephrectomy and the ensuing effect on overall survival.
Using the Surveillance, Epidemiology and End Results database we identified 11,182 patients between 1988 and 2004 who were diagnosed with metastatic renal cell carcinoma. Patients were separated into 2 groups, including those who underwent nephrectomy and those who did not, and they were stratified by the mentioned variables. Logistic regression and Kaplan-Meier analyses were used to determine the likelihood of undergoing nephrectomy and of overall survival in the cohorts.
In the final cohort 3,443 patients (31%) underwent radical nephrectomy. These patients experienced longer median survival than those who did not undergo surgery (11 vs 4 months, p <0.001). The survival benefit was statistically similar regardless of age group, race, gender and marital status. However, nephrectomy was more commonly performed in younger age groups, and in white and married patients. While age group and race were statistically significant predictors of undergoing nephrectomy (OR 0.64, 95% CI 0.61-0.66 and OR 0.79, 95% CI 0.70-0.89, respectively), marital status was the most important predictor (OR 1.52, 95% CI 1.39-1.66).
Patients with metastatic renal cell carcinoma who undergo radical nephrectomy experience a survival advantage over those who do not undergo surgery. Married patients are more likely to undergo nephrectomy than their unmarried counterparts. Physicians must be aware of this bias when selecting patients for nephrectomy.
