The effect of age on cancer-specific mortality in patients with small renal masses: A population-based analysis

Introduction: Contemporary data regarding the effect of age, especially in elderly patients, on cancer-specific mortality (CSM) for pT1a renal cell carcinoma (RCC) are lacking. The objective of the current study is to evaluate CSM in a large population-based cohort of surgically treated pT1a RCC patients according to age groups. Methods: Within the Surveillance Epidemiology and End Results database (2000-2013), we identified 37 121 pT1a RCC patients who underwent either partial or radical nephrectomy. The population was stratified into five groups according to decades: <50, 50-59, 60-69, 70-79, and >= 80 years. The effect of age on CSM was evaluated using competing risks regression models according to Fuhrman grade (FG). Analyses were repeated in clear-cell RCC (ccRCC). Results: Patients aged 50-59 (9615), 60-69 (10 762), 70-79 (7096), and >= 80 (1789) years demonstrated higher rate of CSM compared to patients aged <50 (7856) years (hazard ratios [HR] 2.11, 3.04, 4.47, and 7.56, respectively; all p<0.001). The effect of age on CSM in FG 1-2 patients resulted in HRs ranging from 2.01-8.23 for the same age decades (all p<0.001). Similarly, the effect of age on CSM in FG 3-4 patients resulted in HRs ranging from 2.38-5.92, respectively (all p<0.001). Virtually the same results were recorded in ccRCC patients. Conclusions: Older age is associated with higher CSM in surgically treated patients with pT1a RCC. This effect seems to be more pronounced in patient with FG 1-2 disease. This observation should be considered when making treatment decisions in elderly patients.