Stage and grade dominate RCC outcomes

Oct 22 2013

By Eleanor McDermid, Senior medwireNews Reporter

Tumor grade and American Joint Committee on Cancer stage have emerged as the most important predictors of mortality in a competing risks analysis of patients undergoing nephrectomy for renal cell carcinoma (RCC).

However, noncancer causes of death had a large impact on patients aged 70 years or older, regardless of tumor grade and stage, report Maxine Sun (University of Montreal Health Center, Quebec, Canada) and co-workers, who analyzed data from 42,090 patients in the Surveillance, Epidemiology, and End Results database.

“In consequence, further work is needed regarding the management of elderly patients diagnosed with organ-confined RCC, such as a more comprehensive assessment of the risks and benefits of surgical intervention and better attempts at preventing as well as decreasing postoperative morbidities from treatment,” they write in Urologic Oncology.

Across 5 years of follow-up, cancer-specific mortality (CSM) rates rose significantly with increasing stage, even as patients’ age and tumor grade increased, from 2–9% for stage I to 54–79% for stage IV. Likewise, CSM rose from 2–64% for patients with low-grade tumors to 6–79% for those with high-grade tumors, even as age and stage increased.

Tumor stage and grade were less dominant among patients aged 70 years or older, who were at increased risk for dying of noncancer causes; rates of noncancer death were 11–44% in this age group, compared with 4–14% among younger patients. CSM was still high among elderly patients who had tumors with high grade and/or stage, however.

“This underlines the need of an accurate patient selection even in this group of patients, especially when planning aggressive surgery, or a potentially harmful chemotherapy,” the team comments.

When the researchers looked at outcomes among patients with stage I tumors, they found that patients had significantly higher CSM rates if they underwent radical rather than partial nephrectomy, regardless of age and tumor grade. This “likely stems from unmeasured treatment selection biases,” they say.

Patients aged 70 years or older tended to have higher noncancer death rates after partial than radical nephrectomy, which Sun et al again attribute to selection bias, given that “historically, nephron sparing was less often performed in an elective fashion.”

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