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Increased Use of Nephron-Sparing Surgery in Older Patients With Small Kidney Cancers

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Key Points

  • Use of nephron-sparing surgery increased from 21.5% to 49.0%.
  • Overall survival was improved in patients who received surgical vs nonsurgical treatment, but only nephron-sparing surgery was associated with benefit in cancer-specific survival.

In a study reported in JAMA Surgery, Huang et al found that use of nephron-sparing surgery has more than doubled since 2001 among older patients with small kidney cancers. Use of nonsurgical approaches has remained stable.

Study Details

The study involved Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data from 6,664 patients aged ≥ 66 years with pathologically confirmed small kidney cancer (< 4 cm) diagnosed between January 2001 and December 2009. Analysis was performed between February 2014 and December 2014.

Changes in Use

Overall, 5,994 patients (90.0%) had surgical treatment and 670 (10.0%) were managed nonsurgically. Use of radical nephrectomy decreased over time from 69.0% to 42.5%, use of nephron-sparing surgery (partial nephrectomy and ablation) increased from 21.5% to 49.0%, and  the proportion of patients not undergoing surgery remained stable (change from 9.5% to 8.5%).

Survival

Over a median follow-up of 63 months, 31.8% of patients died, including 4.4% from kidney cancer. Three- and 5-year overall survival probabilities were 73% and 61% in the nonsurgical group, 83% and 72% in the radical nephrectomy group, and 90% and 81% in the nephron-sparing surgery group. In an analysis adjusting for patient and disease characteristics, compared with the nonsurgery group, risk of death was reduced in the radical nephrectomy group (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.66–0.86) and the nephron-sparing surgery group (HR = 0.55, 95% CI = 0.47–0.64; P < .001 for trend).

Three- and 5-year cancer-specific survival probabilities were 95% and 92% in the nonsurgical group, 96% and 95% in the radical nephrectomy group, and 98% and 97% in the nephron-sparing surgery group. Compared with the nonsurgery group, the nephron-sparing surgery group (HR = 0.47, 95% CI = 0.31–0.69) but not the radical nephrectomy group (HR = 0.74, 95% CI = 0.53–1.04) had reduced risk for cancer-specific mortality (P < .001 for trend).

The investigators concluded: “Surgery continues to be the most common treatment for patients with small kidney cancers. The use of nephron-sparing surgery exceeds radical nephrectomy in patients who receive surgery. Although our findings suggest that nonsurgical management is acceptable for certain patients, use of this approach remains low.”

William C. Huang, MD, of New York University Langone Medical Center, is the corresponding author for the JAMA Surgery article.

The authors reported no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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