To predict of the risk of cancer-specific [CSM] or other-cause mortality [OCM] for T1 kidney cancer patients aiming at identifying those who would benefit from surgery over observation.
11,192 T1 kidney cancer patients treated with surgery or observation in the SEER-Medicare database were assessed. A competing risk regression [CRR] model was fitted to predict CSM and OCM after surgery or observation. Covariates consisted of age, gender, race, Charlson comorbidity index [CCI], history of acute kidney injury [AKI] or chronic kidney disease [CKD], tumour size and year of diagnosis.
At a median follow-up of 64 months, the 5-year rates of CSM and OCM were 6.7% and 24%, respectively. At CRR predicting CSM, surgery (HR 0.46; p<0.0001), and year of diagnosis (HR 0.96; p<0.0001) were associated with lower CSM risk. Conversely, age (HR 1.05; p<0.0001), CCI (HR 1.07; p<0.0001) and tumour size (HR 1.03; p<0.0001) were associated with higher CSM risk. At CRR predicting OCM, surgery (HR 0.66; p<0.0001), female gender (HR 0.83; p<0.0001), Other race (HR 0.82; p<0.0001) and year of diagnosis (HR 0.95; p<0.0001) were associated with lower OCM risk. Conversely, age (HR 1.06; p<0.0001), African American race (HR 1.16; p<0.01), CCI (HR 1.17; p<0.0001) and AKI or CKD (HR 1.35; p<0.0001) were associated with higher OCM risk.
The benefit of surgery over observation resulted maximal in younger and healthier patients with larger tumours. The proposed model can aid clinical decision-making providing crucial information on CSM and OCM risk after either treatment modality.
Urology. 2016 Jan 21 [Epub ahead of print]
Alessandro Larcher, Vincent Trudeau, Paolo Dell'Oglio, Zhe Tian, Katharina Boehm, Nicola Fossati, Umberto Capitanio, Alberto Briganti, Francesco Montorsi, Pierre Karakiewicz
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY., Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.