OBJECTIVES: Historical data showed worse perioperative outcomes after cytoreductive nephrectomy (CN) in older patients. Additionally, the CARMENA trial questioned the survival benefit of cytoreductive CN. We reassessed complication, failure to rescue (FTR) and mortality rates after CN in a contemporary cohort of older patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: From National Inpatient Sample (NIS) database (2008-2015), mRCC patients treated with CN were abstracted. Univariable and multivariable logistic regression models tested for the relationship between age (≤55 vs. 56-70 vs ≥71 years), Charlson Comorbidity Index (CCI) and modified Frailty Index (mFI) categories and complications, FTR and in-hospital mortality. All models were clustered, weighted and adjusted for all available patient and hospital characteristics. RESULTS: Of 3644 mRCC patients treated with CN, 924 (25.4%) were ≥ 71 years old, 435 (11.9%) had CCI ≥ 2 and 749 (20.6%) were frail. In multivariable logistic regression models, age ≥ 71 (odds ratio [OR] 1.4, p < .001), CCI ≥ 2 (OR 1.88, p < .001) and frail status (OR 1.91, p < .001) were independent predictors of overall complications. Age ≥ 71 was also an independent predictor of FTR (OR 2.27, p = .04), but not of in-hospital mortality. Both CCI and mFI were not significantly associated with either FTR or in-hospital mortality. CONCLUSION: Older patients with mRCC are more likely to experience higher rates of overall complications, FTR and in-hospital mortality following CN. These results highlight the importance of rigorous selection criteria for older surgical candidates. Moreover, timely recognition and rapid response to complications are particularly critical in this population.

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada; Department of Urology San Luigi Gonzaga Hospital University of Turin Orbassano Turin Italy

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada; Department of Urology University of Montreal Hospital Center Montreal Quebec Canada

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada; Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada; Martini Klinik University Medical Center Hamburg Eppendorf Hamburg Germany

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada; Urology Unit ASST Spedali Civili of Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Departments of Urology Weill Cornell Medical College NY New York USA; Department of Urology University of Texas Southwestern Dallas TX USA; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Medical Oncology Unit ASST Spedali Civili of Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Italy

Urology Unit ASST Spedali Civili of Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Italy

Citace poskytuje Crossref.org

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma