Suk-Ouichai Chalairat, Patel Hiten D, Sato Kent T, Kundu Shilajit D, Ross Ashley E, Perry Kent T
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
J Surg Oncol. 2025 Mar;131(4):742-749. doi: 10.1002/jso.27962. Epub 2024 Oct 29.
Partial (PN)/radical (RN) nephrectomy is the standard treatment for localized renal-cell carcinoma (RCC). The potential risks of these procedures are concerns for the elderly. We evaluated perioperative outcomes/survival for patients aged ≥ 75 years with localized RCC who underwent PN, RN, or thermal ablation (TA).
Localized RCC patients undergoing PN/RN/TA (2000-2023) were retrospectively reviewed. Logistic-regression assessed factors associated with major complications. Kaplan-Meier estimated survival.
A total of 278 patients (≥ 75 years) with RCC who received intervention (107RN, 101PN, and 70TA) were identified. Median age was 78 years. PN patients were younger than other cohorts (77 vs. 79, p = 0.006). Patients with cancer comorbidities underwent TA than PN/RN (93% vs. 88%/76%, respectively). Median tumor size was 4.0, 3.0, and 2.6 cm in RN, PN, and TA cohorts, respectively. RN patients had more complex masses compared to other cohorts (9 vs. 7, p < 0.001). Postoperative complications were significantly greater among PN patients (p = 0.03), but there was no significant difference in Clavien ≥ 3 complications. Peripheral vascular disease (PVD) was associated with Clavien ≥ 3 complications on multivariable analysis (p = 0.03). RN was performed at a stable rate while PN decreased in favor of TA. There was no significant difference in RCC-/non-RCC-specific survival among treatment modalities.
It is important to make informed decisions about treating RCC in the elderly to reduce morbidity/mortality. PVD could be a determining factor favoring TA for amenable tumors.
部分肾切除术（PN）/根治性肾切除术（RN）是局限性肾细胞癌（RCC）的标准治疗方法。这些手术的潜在风险是老年人所关注的问题。我们评估了接受PN、RN或热消融（TA）治疗的≥75岁局限性RCC患者的围手术期结局/生存率。
对2000年至2023年接受PN/RN/TA治疗的局限性RCC患者进行回顾性分析。采用逻辑回归评估与主要并发症相关的因素。采用Kaplan-Meier法估计生存率。
共确定了278例接受干预的≥75岁RCC患者（107例接受RN，101例接受PN，70例接受TA）。中位年龄为78岁。PN组患者比其他队列的患者年轻（77岁对79岁，p = 0.006）。合并癌症的患者接受TA治疗的比例高于PN/RN组（分别为93%对88%/76%）。RN、PN和TA组的肿瘤中位大小分别为4.0、3.0和2.6 cm。与其他队列相比，RN组患者的肿块更复杂（9对7，p < 0.001）。PN组患者的术后并发症明显更多（p = 0.03），但Clavien≥3级并发症无显著差异。多变量分析显示外周血管疾病（PVD）与Clavien≥3级并发症相关（p = 0.03）。RN的实施率稳定，而PN的实施率下降，TA的实施率上升。不同治疗方式之间的RCC特异性/非RCC特异性生存率无显著差异。
在老年RCC患者的治疗中做出明智的决策以降低发病率/死亡率很重要。PVD可能是适合TA治疗的肿瘤的决定性因素。
