Abstract: PD52-12
Sources of Funding: None

Introduction

Older patients are more likely to be diagnosed with renal cell carcinoma and to have a lower overall survival based on age and associated co-morbidities. Decisions regarding the pursuit of surgical therapy are impacted by competing risks for perioperative mortality. We utilized the National Cancer Database (NCDB) to evaluate 90-day mortality and developed a nomogram predicting short-term mortality after renal cell carcinoma surgery.

Methods

The NCDB for kidney cancer was queried to identify all patients with clinically localized, non-metastatic disease who were treated with partial or radical nephrectomy. Those patients with incomplete data were excluded. Logistic regression was performed on a random sample of 60% of the dataset to identify preoperative variables associated with 90-day mortality. Variables included age, sex, race, comorbidity score, tumor diameter, and presence of tumor thrombus. A nomogram was built from the logistic regression model and tested on the remaining 40% of the patients in the dataset for the ability to predict 90-day mortality.

Results

183,407 patients were identified that met inclusion criteria (median age 61.1). Overall 90-day mortality for the cohort was 1.9%. Odds ratios for 90-day mortality using preoperative variables are shown in Table 1. The nomogram ranged from 0-14 (Table 1). Median (IQR) nomogram score was 2 (1-4). Twelve percent of patients had nomogram score of 6 or higher. Compared to patients with 0-1 points, those with 2-3 (OR 2.69, 2.26-3.20; p < 0.001), 4-5 (OR 5.98, 5.06-7.06; p < 0.001), and 6+ (OR 12.34, 10.46-14.55; p < 0.001) were at incrementally significantly higher odds of 90-day mortality (Figure 1). Being greater than 80 years of age placed patients into the highest category of mortality.

Conclusions

Management of localized kidney cancer must consider competing causes of mortality, especially in elderly patients with multiple co-morbidities. We present a preoperative tool to calculate risk of surgical short-term mortality to aid in surgeon-patient counseling.

Funding

None