Comparison of partial vs radical nephrectomy with regard to other-cause mortality in T1 renal cell carcinoma among patients aged >= 75 years with multiple comorbidities

Objective To quantify the effect of partial nephrectomy (PN) vs radical nephrectomy (RN) on other-cause mortality (OCM) in elderly patients with localized renal cell carcinoma (RCC) and/or multiple comorbidities. Methods Using the Surveillance, Epidemiology, and End Results Medicare-linked database, patients with T1 RCC, aged >= 75 years, or who had >= 2 comorbidities, were identified (1988-2005). To adjust for inherent differences between treatment types, propensity-based matched analyses were performed. Competing-risks regression analyses for prediction of OCM were assessed according to treatment type. The effect of PN and RN on OCM was examined in three sub-groups: patients aged >= 75 years; patients with >= 2 comorbidities; and patients aged >= 75 years with >= 2 comorbidities. Results After propensity-based matched analyses and adjustment for all covariates, PN was found to exert a protective effect relative to RN with respect to OCM in all patients (hazard ratio [HR]: 0.84, P = 0.048). In subanalyses, no difference was recorded between PN and RN in patients who were aged >= 75 years (HR: 0.83, P = 0.2), with >= 2 baseline comorbidities at diagnosis (HR: 0.83, P = 0.1), or in patients who were aged >= 75 years and who had >= 2 baseline comorbidities (HR: 0.77, P = 0.2). Conclusions Some elderly patients and/or those with multiple comorbidities at diagnosis may not benefit from PN with respect to OCM. After rigorous patient selection, alternative treatment options could be considered.