Patients age 75 years or older who have confined kidney tumors do not live longer if they have their entire kidney removed, a study in Cancer has found. The results showed that such patients typically have other medical problems of greater significance and that many should receive more conservative cancer-related care, such as observation or treatments that spare the noncancerous parts of their kidneys.
The incidence of kidney cancer has been on the rise over the past decade, and the greatest increase has been observed in the later years of life, but the specific treatment approach has not been definitive.
To investigate whether nephrectomy extends survival when compared with active monitoring or kidney-sparing surgery, Steve Campbell, MD, PhD, of the Cleveland Clinic and colleagues studied information from 537 patients with localized kidney tumors that were up to 7 cm in diameter and were detected at age 75 or older. Twenty percent of these patients were closely observed, 53% had kidney-sparing surgery, and 27% underwent a nephrectomy.
After an average follow-up period of about four years, 28% of the patients had died. The most common cause of death was heart-related (29%). Cancer progression was responsible for only 4% of deaths. Older age and additional medical conditions increased patients' risk of dying during the follow-up period, but the choice of treatment did not.
The analysis also showed that patients who had a cancerous kidney removed experienced accelerated dysfunction of their remaining kidney. Kidney removal also appeared to increase patients' risk of dying from cardiovascular causes.
“Current research is indicating over-treatment of localized renal tumors, and our data suggest that active surveillance is a reasonable strategy and one that is greatly underutilized in the elderly population,” the authors wrote.