Differences in other-cause mortality in metastatic renal cell carcinoma according to partial vs. radical nephrectomy and age: a propensity score matched study

Abstract

Introduction: It is unknown whether the benefit from partial nephrectomy regarding lower other-cause mortality is applicable to older patients with metastatic renal cell carcinoma. Materials and methods: Using Surveillance Epidemiology and End Results database, patients with metastatic renal cell carcinoma, undergoing partial or radical nephrectomy, were stratified according to age (<60, 60-69, and >= 70 years). After propensity score matching, Kaplan-Meier survival analyses and multivariable Cox regression models were used. Results: Of 2,390 patients with metastatic renal cell carcinoma, 885 (37%) were aged <60 years, and 90 (10%) underwent partial nephrectomy; 824 (34%) were aged 60-69 years, and 61 (7%) underwent partial nephrectomy; and 681 (29%) were aged >= 70 years, and 64 (9%) underwent partial nephrectomy. After propensity score matching, in patients aged <60 years, partial nephrectomy was associated with lower other-cause mortality (hazard ratio 0.22; p = 0.02); in patients aged 60-69 years, partial nephrectomy was associated with lower othercause mortality (hazard ratio 0.38; p = 0.03); but not in patients aged >= 70 years. Discussion: In metastatic renal cell carcinoma, partial nephrectomy is associated with lower other-cause mortality in patients aged <60 years and in patients aged 60-69 years, but not in patients aged >= 70 years. In consequence, consideration of partial nephrectomy might be of great value in younger metastatic renal cell carcinoma patients.