Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: A competing risks analysis Journal Article


Authors: Larcher, A.; Trudeau, V.; Sun, M.; Boehm, K.; Meskawi, M.; Tian, Z.; Fossati, N.; Dell'Oglio, P.; Capitanio, U.; Briganti, A.; Shariat, S. F.; Montorsi, F.; Karakiewicz, P. I.
Article Title: Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: A competing risks analysis
Abstract: Objectives: To examine, using competing risks regression, differences in cancer-specific mortality (CSM) that might distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer. Patients and Methods: The study focused on 1 860 patients with cT1a kidney cancer treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results-Medicare database. Propensity-score matching was used. The study outcome was CSM. Multivariable competing risks regression analyses, adjusting for other-cause mortality as well as patient (including comorbidities) and tumour characteristics, were fitted. Results: Overall, fewer patients underwent LTA than OBS (30 vs 70%; n = 553 vs n = 1 307). Compared with patients in the OBS group, those in the LTA group were younger (median age 77 vs 78 years; P < 0.001), more likely to be white (84 vs 78%; P = 0.005), more frequently married (59 vs 52%; P = 0.02) and more frequently of high socio-economic status (54 vs 45%; P = 0.001). After propensity-score matching, 553 patients who underwent LTA and 553 who underwent OBS remained for subsequent analyses. The mean standardized differences of patient characteristics between the two groups were <10%, indicating a high degree of similarity. After LTA or OBS, the 5-year CSM estimates from Poisson regression-derived smoothed plots were 3.5 and 9.1%, respectively. In multivariable competing risks regression analyses, LTA use was found to have a protective effect on CSM (hazard ratio 0.47 [95% confidence interval 0.25–0.89]; P = 0.02). Conclusions: After adjustment for comorbidity and tumour characteristics in elderly patients with kidney cancer, LTA was associated with a clinically and statistically significant protective effect on CSM, compared with OBS. This advantage of LTA deserves consideration when obtaining informed consent. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd
Keywords: kidney cancer; observation; oncological outcomes; elderly patients; local tumour ablation; non-surgical management
Journal Title: BJU International
Volume: 118
Issue: 4
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2016-10-01
Start Page: 541
End Page: 546
Language: English
DOI: 10.1111/bju.13326
PUBMED: 26384713
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 3 October 2016 -- Source: Scopus
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  1. Nicola   Fossati
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