Long-term Survival Following Partial vs Radical Nephrectomy Among Older Patients With Early-Stage Kidney Cancer

CONTEXT Although partial nephrectomy is the preferred treatment for many patients with early-stage kidney cancer, recent clinical trial data, which demonstrate better survival for patients treated with radical nephrectomy, have generated new uncertainty regarding the comparative effectiveness of the...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2012-04, Vol.307 (15), p.1629-1635
Main Authors: Tan, Hung-Jui, Norton, Edward C, Ye, Zaojun, Hafez, Khaled S, Gore, John L, Miller, David C
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Cancer
Cause of Death
clinical trials
Cohort Studies
Female
General aspects
Humans
Kaplan-Meier Estimate
Kidney
Kidney diseases
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Kidneys
Male
Medical sciences
Medicare - statistics & numerical data
Mortality
Neoplasm Staging
Nephrectomy - methods
Nephrectomy - mortality
Nephrology. Urinary tract diseases
Older people
Retrospective Studies
Risk
Risk assessment
SEER Program - statistics & numerical data
surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Surgical outcomes
survival
Survival analysis
Tumors of the urinary system
United States
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Summary:CONTEXT Although partial nephrectomy is the preferred treatment for many patients with early-stage kidney cancer, recent clinical trial data, which demonstrate better survival for patients treated with radical nephrectomy, have generated new uncertainty regarding the comparative effectiveness of these treatment options. OBJECTIVE To compare long-term survival after partial vs radical nephrectomy among a population-based patient cohort whose treatment reflects contemporary surgical practice. DESIGN, SETTING, AND PATIENTS We performed a retrospective cohort study of Medicare beneficiaries with clinical stage T1a kidney cancer treated with partial or radical nephrectomy from 1992 through 2007. Using an instrumental variable approach to account for measured and unmeasured differences between treatment groups, we fit a 2-stage residual inclusion model to estimate the treatment effect of partial nephrectomy on long-term survival. MAIN OUTCOME MEASURES Overall and kidney cancer–specific survival. RESULTS Among 7138 Medicare beneficiaries with early-stage kidney cancer, we identified 1925 patients (27.0%) treated with partial nephrectomy and 5213 patients (73.0%) treated with radical nephrectomy. During a median follow-up of 62 months, 487 (25.3%) and 2164 (41.5%) patients died following partial or radical nephrectomy, respectively. Kidney cancer was the cause of death for 37 patients (1.9%) treated with partial nephrectomy, and 222 patients (4.3%) treated with radical nephrectomy. Patients treated with partial nephrectomy had a significantly lower risk of death (hazard ratio [HR], 0.54; 95% CI, 0.34-0.85). This corresponded with a predicted survival increase with partial nephrectomy of 5.6 (95% CI, 1.9-9.3), 11.8 (95% CI, 3.9-19.7), and 15.5 (95% CI, 5.0-26.0) percentage points at 2, 5, and 8 years posttreatment (P 
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2012.475