Rodríguez-Covarrubias F, Rivera-Ramirez J A, Gabilondo-Pliego B, Castillejos-Molina R A, Sotomayor M, Feria-Bernal G, Gabilondo-Navarro F
Departamento de Urología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de México, México.
Departamento de Urología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de México, México.
Actas Urol Esp. 2016 Jul-Aug;40(6):395-9. doi: 10.1016/j.acuro.2016.01.009. Epub 2016 Mar 8.
To describe the oncological characteristics and evolution of patients 65 years or older who underwent surgery for renal-cell carcinoma (RCC).
We reviewed our prospectively maintained database of patients with RCC treated surgically. Those ≥ 65 years old were selected. We analyzed clinical and pathological characteristics as well as oncological and functional outcomes. Overall survival (OS) was estimated with the Kaplan-Meier method. Multivariate Cox-proportional hazards model was used to determine predictors of OS.
A total of 156 elderly patients with mean age 72.0±5.5 years (range 65-92) and median follow-up of 33 months were included. Surgical approach was open radical nephrectomy in 114 (73.5%), laparoscopic radical nephrectomy in 13 (8.4%), open partial nephrectomy in 23 (14.2%) and laparoscopic partial nephrectomy in 6 (3.9%). Pathological stage was: Stage I, 71 (45.5%); Stage II, 27 (17.3%); Stage III, 48 (30.8%); and Stage IV, 10 (6.4%). Lastly, 51 (32.6%) patients died, 22 (43.1%) from cancer. The 5-year OS according to pathological stage was 77.6%, 71.9%, 45.1% and 11.7% for stage I, II, III and IV, respectively (P<.001). On multivariate analysis, pathological stage independently predicted OS (HR 1.96, 95% CI [1.36-2.84], P=.0003).
The surgical management of RCC appears to be safe in properly selected patients 65 years or older. Pathological stage predicts survival in this population.
描述65岁及以上接受肾细胞癌（RCC）手术患者的肿瘤学特征及病情演变。
我们回顾了前瞻性维护的接受手术治疗的RCC患者数据库。选择年龄≥65岁的患者。分析其临床和病理特征以及肿瘤学和功能结局。采用Kaplan-Meier法估计总生存期（OS）。使用多变量Cox比例风险模型确定OS的预测因素。
共纳入156例老年患者，平均年龄72.0±5.5岁（范围65 - 92岁），中位随访时间33个月。手术方式为开放性根治性肾切除术114例（73.5%），腹腔镜根治性肾切除术13例（8.4%），开放性部分肾切除术23例（14.2%），腹腔镜部分肾切除术6例（3.9%）。病理分期为：I期71例（45.5%）；II期27例（17.3%）；III期48例（30.8%）；IV期10例（6.4%）。最后，51例（32.6%）患者死亡，22例（43.1%）死于癌症。I、II、III和IV期患者的5年OS分别为77.6%、71.9%、45.1%和11.7%（P<0.001）。多变量分析显示，病理分期是OS的独立预测因素（HR 1.96，95%CI[1.36 - 2.84]，P = 0.0003）。
对于经过适当选择的65岁及以上患者，RCC的手术治疗似乎是安全的。病理分期可预测该人群的生存情况。
