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Active surveillance for small renal masses in elderly patients does not increase overall mortality rates compared to primary intervention: a propensity score weighted analysis

Authors
 Michele Marchioni  ;  Joseph G Cheaib  ;  Toshio Takagi  ;  Nicola Pavan  ;  Alessandro Antonelli  ;  Wourter Everaerts  ;  Matthias Heck  ;  Koon H Rha  ;  Alexandre Mottrie  ;  Jihad Kaouk  ;  Umberto Capitanio  ;  Estevão Lima  ;  Alessandro Veccia  ;  Simone Crivellaro  ;  Estefania Linares  ;  Antonio Celia  ;  Francesco Porpiglia  ;  Riccardo Autorino  ;  Marta DI Nicola  ;  Luigi Schips  ;  Phillip M Pierorazio  ;  Maria Carmen Mir 
Citation
 MINERVA UROLOGY AND NEPHROLOGY, Vol.73(6) : 781-788, 2021-12 
Journal Title
MINERVA UROLOGY AND NEPHROLOGY
ISSN
 2724-6051 
Issue Date
2021-12
MeSH
Aged ; Humans ; Kidney Neoplasms* / surgery ; Nephrectomy ; Propensity Score ; Proportional Hazards Models ; Watchful Waiting*
Abstract
Background: The aim of the study was to test the effect of active surveillance (AS) versus primary intervention (PI) on overall mortality (OM) in elderly patients diagnosed with SRM.

Methods: Elderly patients (75 years or older) diagnosed with SRMs (<4 cm) and treated with either PI (i.e. partial nephrectomy or kidney ablation) or AS between 2009 and 2018 were abstracted from the renal surgery in the elderly (RESURGE) and Delayed Intervention and Surveillance for small Renal Masses (DISSRM) datasets, respectively. OM rates were estimated among groups with Kaplan Meier method and Cox proportional hazards regression models after applying inverse probability of treatment weighting (IPTW). Multivariable logistic regression model was used to estimate IPTW. Covariates of interest were those unbalanced and/or significantly correlated with the treatment choice or with OM.

Results: A total of 483 patients were included; 121 (25.1%) underwent AS. Sixty patients (12.4%) died. Overall, 6.7% of all deaths were related to cancer. IPTW-Kaplan Meier curves showed a 5-year overall survival rates of 70.0±3.5% and 73.2±4.8% in AS and PI groups, respectively (IPTW-Log-rank P value=0.308). IPTW-Cox regression model did not show meaningfully increased OM rates in AS group (HR: 1.31, 95% CI: 0.69-2.49).

Conclusions: AS represents an appealing treatment option for very elderly patients presenting with SRM, as it avoids the risks of a PI while not compromising the survival outcomes of these patients.
Full Text
https://www.minervamedica.it/en/journals/minerva-urology-nephrology/article.php?cod=R19Y2021N06A0781
DOI
10.23736/S2724-6051.20.03785-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191103
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