The Type of Nephrectomy Has Little Effect on Overall Survival or Cardiac Events in Patients of 70 Years and Older With Localized Clinical T1 Stage Renal Masses
경윤수, 유달산, 권택민, 송상훈, 정인갑, 송채린, 홍범식, 홍준혁, 안한중, 김청수,
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경윤수 ( Kyung Yoon-Soo )
University of Ulsan College of Medicine Asan Medical Center Health Screening and Promotion Center
유달산 ( You Dal-San )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
권택민 ( Kwon Taek-Min )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
송상훈 ( Song Sang-Hoon )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
정인갑 ( Jeong In-Gab )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
송채린 ( Song Che-Ryn )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
홍범식 ( Hong Bum-Sik )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
홍준혁 ( Hong Jun-Hyuk )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
안한중 ( Ahn Han-Jong )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
김청수 ( Kim Choung-Soo )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
KMID : 0358320140550070446
Abstract
Purpose: To compare the outcomes of nephron-sparing options (e.g., partial nephrectomy [PN]) and low-surgical-morbidity options (e.g., radical nephrectomy [RN]) in elderly patients with limited life expectancy.
Materials and Methods: We retrospectively reviewed 135 patients aged 70 years or older who underwent RN (n=82) or PN (n=53) for clinical T1 stage renal masses between January 2000 and December 2012. Clinicopathologic data were thoroughly analyzed and compared between the RN and PN groups. The modification of diet in renal disease equation was used to estimate glomerular filtration. Overall survival and cardiac events were assessed by using Kaplan-Meier survival analysis and Cox proportional-hazards regression modeling.
Results: Over a median follow-up period of 59.72 months, 17 patients (20.7%) in the RN group and 3 patients (5.7%) in the PN group died. Chronic kidney disease (<60 mL/min/1.73 m2) developed more frequently in RN patients than in PN patients (75.6% vs. 41.5%, p<0.001). The 5-year overall survival rate did not differ significantly between the RN and PN groups (90.7% vs. 93.8%; p=0.158). According to the multivariate analysis, the Charlson comorbidity index score was an independent predictor of overall survival (hazard ratio [HR], 2.679, p=0.037). Type of nephrectomy was not significantly associated with overall survival (HR, 2.447; p=0.167) or cardiac events (HR, 1.147; p=0.718).
Conclusions: Although chronic kidney disease was lower after PN, overall survival and cardiac events were similar regardless of type of nephrectomy.
키워드
Aged;Cardiovascular diseases;Kidney;Mortality;Nephrectomy
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