Introduction

Accurate estimation of long-term risk of cancer-specific [CSM] and other-cause mortality [OCM] is of utmost importance for clinical management of patients diagnosed with kidney cancer. The aim of the study is to assess long-term mortality rates of a contemporary cohort of patients surgically treated for non-metastatic kidney cancer.

Methods

1,704 patients with non-metastatic kidney cancer treated with either radical or partial nephrectomy between 1987 and 2015 in a prospectively collected institutional database were assessed. Outcomes of the study were the 10-year rates of CSM and OCM. A multivariable competing risk regression model was fitted to predict CSM and OCM. Covariates consisted of age, gender, Charlson comorbidity index [CCI], pre-operative estimated glomerular filtration rate, haemoglobin and platelets, clinical tumour size, clinical tumour [cT] and nodal stage [cN], presence of local symptoms at diagnosis and year of surgery. Smoothed Poisson's incidence plots were used to estimate 10-year CSM and OCM rates in the overall population as well as in 4 sub-cohorts defined as: A.age ?60 and stage T1; B.age >60 and stage T1; C.age ?60 and stage >T1; D.age >60 with stage >T1

Results

At a median follow-up of 72 months, 10-year rates of CSM and OCM were 11 and 14%, respectively. At competing risk regression analysis, age, platelets, cT and cN resulted associated with higher risk of CSM (all p<0.05). Conversely, female gender and year of diagnosis were associated with lower risk of CSM (all p<0.05). Moreover, age, CCI and tumour size resulted associated with higher risk of OCM (all p<0.05). Conversely, female gender and year of diagnosis were associated with lower risk of OCM (all p<0.05). After stratification according to age and cT (Figure 1), the 10-year CSM and OCM rates resulted 3.4 and 5% in group A; 8 and 24% in group B; 22 and 7.7% in group C and 31 and 24% in group D, respectively.

Conclusions

The relative impact on CSM and OCM in patients treated with surgery for kidney cancer is extremely heterogeneous according to host and cancer characteristics. The 10-years rates of CSM and OCM resulted 3.4 and 5% in younger patients with cT1 and 31 and 24% in older patients with cT2 or higher stage. These figures can aid clinical decision making providing a precise long-term mortality risk estimation.

Funding

none