The management of renal cell carcinoma in the elderly

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May 10 2006

The median age of presentation for patients with renal cell carcinoma (RCC) is in the 6th decade of life, but urologists are not uncommonly confronted with an elderly patient (>75 years of age) with a renal mass seeking treatment.

As the population ages, co-morbidities become more confounding in predicting patient outcome to therapy, and may influence the application of surgical therapy with curative intent to elderly patients. In this study by Berdjis and colleagues out of Germany, the outcome of elderly patients (defined as >75 years of age) is examined relative to a younger patient cohort.

Over a 10 year period, 1023 patients underwent radical or partial nephrectomy for RCC at a single institution. Of these, 115 patients were >75 years of age. Patients in the older cohort had a higher incidence of co-morbid conditions, as evidenced by their higher American Society of Anesthesia (ASA) scores (p<0.05). The incidence of complications in the younger cohort was 3.4% and 1.7% in the older cohort. Peri-operative mortality was 1.7% in the older cohort and 0.3% in the younger cohort (p=0.29). There was no difference in stage, grade, or indication for nephrectomy (curative versus palliative) between the two groups. In this study, morbidity (p=0.05) and peri-operative mortality (p=0.008) correlated with ASA score but not patient age.

This study emphasizes that it is physiologic age, not chronologic age, that must be considered in offering patients surgical therapy for RCC. While it remains true that older patients are more likely to have increased co-morbid conditions, those elderly patients in relative good health will do well and derive benefit from definitive surgical intervention.

By Christopher G. Wood, MD

Reference:

BJU Int. 97: 703-705, 2006

http://www.ncbi.nlm.nih.gov/entrez/