May Matthias, Cindolo Luca, Zigeuner Richard, De Cobelli Ottavio, Rocco Bernardo, De Nunzio Cosimo, Tubaro Andrea, Coman Ioman, Truss Michael, Dalpiaz Orietta, Wolff Ingmar, Feciche Bogdan, Fenske Fabian, Pichler Martin, Schips Luigi, Figenshau Robert S, Madison Kerry, Sánchez-Chapado Manuel, Santiago Martin Maria del Carmen, Salzano Luigi, Lotrecchiano Giuseppe, Waidelich Raphaela, Stief Christian, Sountoulides Petros, Brookman-May Sabine
Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany.
Department of Urology, San Pio da Pietrelcina Hospital, Vasto, Italy.
Urol Oncol. 2014 Nov;32(8):1252-8. doi: 10.1016/j.urolonc.2014.04.013. Epub 2014 Aug 14.
To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC) ≥ 80 years of age in comparison with patients between the ages of 60 and 70 years.
The data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters.
Significantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P<0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivariable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P<0.001) were detectable in octogenarians (c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P<0.001), but not for CSM. Limitations are based on the retrospective study design.
Octogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.
分析80岁及以上接受手术治疗的肾细胞癌（RCC）患者的临床病理特征和生存率，并与60至70岁的患者进行比较。
从一个跨国数据库（肾肿瘤协作研究协会[CORONA]）中检索了2516例患者的数据，中位随访时间为57个月，其中包括6234例接受根治性或部分肾切除术后连续的RCC患者。对241例八旬老人（占数据库的3.9%）和2275例60至70岁的参照患者（占36.5%）的临床病理特征进行了比较分析。应用校正竞争风险的多变量回归分析来确定高龄对癌症特异性死亡率（CSM）和其他原因死亡率（OCM）的影响。此外，采用工具变量分析以减少未测量参数造成的残余混杂。
八旬老人中女性明显更多（50%对40%，P = 0.004），与参照组相比，八旬老人接受保留肾单位手术的频率明显更低（11%对20%，P<0.001）。尽管肿瘤中位大小和分期没有显著差异，但老年患者出现晚期或转移性疾病（N+/M1）的情况较少（4.6%对9.6%，P = 0.009）。在多变量分析中，八旬老人的CSM（风险比=1.48，P = 0.042）和OCM率（风险比=4.32，P<0.001）更高（c指数分别为0.85和0.72）。将年龄组变量纳入多变量模型显著提高了关于OCM的预测准确性（6%，P<0.001），但对CSM没有提高预测准确性。局限性基于回顾性研究设计。
与年轻患者相比，八旬老人RCC患者的临床特征有显著差异，且CSM和OCM率显著更高。
