Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life

Matthias May, Luca Cindolo, Richard Zigeuner, Ottavio De Cobelli, Bernardo Rocco, Cosimo De Nunzio, Andrea Tubaro, Ioman Coman, Michael Truss, Orietta Dalpiaz, Ingmar Wolff, Bogdan Feciche, Fabian Fenske, Martin Pichler, Luigi Schips, Robert S. Figenshau, Kerry Madison, Manuel Sánchez-Chapado, Maria del Carmen Santiago Martin, Luigi SalzanoGiuseppe Lotrecchiano, Raphaela Waidelich, Christian Stief, Petros Sountoulides, Sabine Brookman-May

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives: To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC)≥80 years of age in comparison with patients between the ages of 60 and 70 years. Materials and methods: The data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters. Results: Significantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P<0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivariable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P<0.001) were detectable in octogenarians (c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P<0.001), but not for CSM. Limitations are based on the retrospective study design. Conclusions: Octogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.

Original languageEnglish
Pages (from-to)1252-1258
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Issue number8
StatePublished - 2014


  • Cancer-specific mortality
  • Competing risks regression analysis
  • Instrumental variable
  • Nephrectomy
  • Octogenarians
  • Renal cell carcinoma


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