The Effect of Cytoreductive Partial Nephrectomy in Elderly Patients with Metastatic Renal Cell Carcinoma

Figures & data

Table 1 The Portion and Distribution of Clinical Features of Elderly Patients with Metastatic Renal Cell Carcinoma Before and After Propensity Matching

Variable	Before PSM (n=1264)			After PSM (n=208)
	PN (n=78, %)	RN (n=1186, %)	p-value	PN (n=59, %)	RN (n=149, %)	p-value
Age at diagnosis, years	71.59 ± 5.22	72.11 ± 5.57	0.425	71.39 ± 5.04	72.34 ± 5.93	0.278
Race			0.264			0.067
Black	7 (9.0%)	63 (5.3%)		6 (10.2%)	4 (2.7%)
White	68 (87.2%)	1043 (87.9%)		51 (86.4%)	132 (88.6%)
Other^a	3 (3.8%)	80 (6.7%)		2 (3.4%)	13 (8.7%)
Gender			0.325			0.411
Male	56 (71.8%)	784 (66.1%)		43 (72.9%)	98 (65.8%)
Female	22 (28.2%)	402 (33.9%)		16 (27.1%)	51 (34.2%)
Marital Status			0.786			0.354
Single^b	20 (25.6%)	346 (29.2%)		14 (23.7%)	49 (32.9%)
Married	56 (71.8%)	799 (67.4%)		43 (72.9%)	97 (65.1%)
Unknown	2 (2.6%)	41 (3.5%)		2 (3.4%)	3 (2.0%)
Insurance Status			1.000			1.000
Insured	78 (100.0%)	1166 (98.3%)		59 (100.0%)	147 (98.7%)
Uninsured	0 (0.0%)	8 (0.7%)		0 (0.0%)	1 (0.7%)
Unknown	0 (0.0%)	12 (1.0%)		0 (0.0%)	1 (0.7%)
Site			1.000			0.645
Right	36 (46.2%)	551 (46.5%)		27 (45.8%)	75 (46.2%)
Left	42 (53.8%)	634 (53.5%)		32 (54.2%)	74 (49.7%)
Unknown	0 (0.0%)	1 (0.1%)		0 (0.0%)	0 (0.0%)
Histologic Type			0.055			0.417
ccRCC	61 (78.2%)	894 (75.4%)		47 (79.7%)	112 (75.2%)
pRCC	11 (14.1%)	72 (6.1%)		7 (11.9%)	12 (8.1%)
chRCC	0 (0.0%)	14 (1.2%)		0 (0.0%)	0 (0.0%)
CDC	0 (0.0%)	10 (0.8%)		0 (0.0%)	1 (0.7%)
SRCC	3 (3.8%)	72 (6.1%)		3 (5.1%)	8 (5.4%)
Other	3 (3.8%)	124 (10.5%)		2 (3.4%)	16 (10.7%)
Tumor Size,cm			< 0.001			0.431
≤4	29 (37.2%)	74 (6.2%)		13 (22.0%)	20 (13.4%)
4–7	23 (29.5%)	319 (26.9%)		20 (33.9%)	61 (40.9%)
> 7	25 (32.1%)	781 (65.9%)		25 (42.4%)	65 (43.6%)
Unknown	1 (1.3%)	12 (1.0%)		1 (1.7%)	3 (2.0%)
Fuhrman Grade			0.607			0.925
Grade 1	1 (1.3%)	13 (1.1%)		1 (1.7%)	3 (2.0%)
Grade 2	18 (23.1%)	207 (17.5%)		13 (22.0%)	30 (20.1%)
Grade 3	25 (32.1%)	417 (35.2%)		19 (32.2%)	56 (37.6%)
Grade 4	22 (28.2%)	387 (32.6%)		19 (32.2%)	40 (26.8%)
Unknown	12 (15.4%)	162 (13.7%)		7 (11.9%)	20 (13.4%)
T Stage			< 0.001			0.090
T1	41 (52.6%)	147 (12.4%)		22 (37.3%)	46 (30.9%)
T2	9 (11.5%)	134 (11.3%)		9 (15.3%)	14 (9.4%)
T3	20 (25.6%)	772 (65.1%)		20 (33.9%)	77 (51.7%)
T4	8 (10.3%)	125 (10.5%)		8 (13.6%)	10 (6.7%)
Unknown	0 (0.0%)	8 (0.7%)		0 (0.0%)	2 (1.3%)
N Stage			0.115			1.000
N0	63 (80.8%)	840 (70.8%)		47 (79.7%)	116 (77.9%)
N1	12 (15.4%)	302 (25.5%)		10 (16.9%)	27 (18.1%)
Unknown	3 (3.8%)	44 (3.7%)		2 (3.4%)	6 (4.0%)
Metastasis Sites			0.516			0.406
One Site	65 (83.3%)	967 (81.5%)		49 (83.1%)	118 (79.2%)
Two Sites	10 (12.8%)	191 (16.1%)		7 (11.9%)	27 (18.1%)
≥Three Sites	3 (3.8%)	28 (2.4%)		3 (5.1%)	4 (2.7%)

Notes: ^aOther: American Indian/AK Native, Asian/Pacific Islander and other races; ^bSingle: Never married, Domestic Partner, Widowed, Separated or Divorced.

Abbreviations: PSM, Propensity Score Matching； PN, Partial Nephrectomy; RN, Radical Nephrectomy; ccRCC, Clear Cell Renal Cell Carcinoma; pRCC, Papillary Renal Cell Carcinoma; chRCC, Chromophobe Renal Cell Carcinoma; CDC, Collecting Duct Carcinoma; sRCC, Sarcomatoid Renal Cell Carcinoma.

Figure 1 Kaplan–Meier curves of overall survival for elderly metastatic renal cell carcinoma according to cytoreductive nephrectomy (A), partial nephrectomy and radical nephrectomy (B, C).

Table 2 Survival Comparison of PN and RN Among Different Subgroups of Elderly Metastatic Renal Cell Carcinoma

Variable	Mean Survival Time of OS, Months (95% CI)		p-value	Mean Survival Time of CSS, Months (95% CI)		p-value
	PN(n=78)	RN(n=1186)		PN(n=78)	RN(n=1186)
Gender
Male	35.30 (27.62–42.98)	27.35 (25.30–29.41)	0.032	42.29 (34.51–50.07)	34.07 (31.63–36.51)	0.036
Female	30.13 (19.70–40.55)	2.22 (21.73–26.71)	0.263	33.78 (23.18–44.38)	29.92 (26.89–32.95)	0.351
Histologic Type
ccRCC	36.77 (29.30–44.25)	29.46 (27.56–31.36)	0.059	41.37 (33.77–48.97)	35.85 (33.62–38.08)	0.129
Other	27.31 (13.53–41.09)	16.29 (13.69–18.90)	0.067	39.54 (24.41–54.67)	22.00 (18.51–25.49)	0.038
Tumor Size, cm
≤7	43.39 (35.37–51.42)	28.49 (25.68–31.30)	0.002	48.34 (40.57–56.12)	35.10 (31.78–38.42)	0.006
> 7	18.95 (10.87–27.02)	24.96 (23.02–26.90)	0.410	26.00 (35.90–56.87)	31.15 (28.80–33.50)	0.606
Grade
G1-2	42.04 (30.43–53.66)	37.01 (33.15–40.88)	0.227	52.98 (43.80–62.16)	44.14 (39.93–48.36)	0.067
G3-4	31.93 (23.19–40.68)	22.75 (20.91–24.59)	0.061	37.66 (28.45–46.87)	28.89 (26.57–31.22)	0.085
T Stage
T1	41.83 (33.48–50.18)	33.18 (28.31–38.04)	0.086	48.16 (40.49–55.83)	39.52 (34.02–45.01)	0.050
T2	32.30 (18.22–46.39)	31.83 (26.99–36.68)	0.479	36.47 (22.42–50.51)	39.48 (34.13–44.84)	0.659
T3	24.13 (13.93–34.32)	25.16 (23.22–27.10)	0.811	28.75 (17.46–40.03)	31.23 (28.87–33.59)	0.852
T4	18.88 (0.7337.02)	17.31 (13.42–21.20)	0.927	25.62 (5.01–46.24)	23.41 (18.03–28.78)	0.722
N Stage
N0	42.11 (34.83–49.40)	29.97 (27.98–31.96)	0.002	47.86 (40.81–54.90)	36.35 (34.03–38.67)	0.003
N1	7.17 (3.80–10.53)	16.32 (13.90–18.75)	0.026	9.64 (4.43–14.85)	22.04 (18.65–25.42)	0.048
Number of Metastasis Sites
One	37.80 (30.50–45.11)	28.36 (26.51–30.20)	0.011	44.61 (37.26–51.96)	34.90 (32.73–37.08)	0.009
≥Two	20.39 (7.96–32.81)	17.28 (14.54–20.01)	0.664	23.50 (10.12–36.88)	22.26 (18.63–25.89)	0.993

Abbreviations: OS, Overall Survival；CSS, Cancer-Specific Survival; 95% CI, 95% Confidence Interval； PN, Partial Nephrectomy; RN, Radical Nephrectomy; ccRCC, Clear cell Renal cell carcinoma.

Figure 2 Survival comparison of patients undergoing cytoreductive nephrectomy according to tumor size ≤7cm (A), isolated metastasis (B) and N0 stage (C) and N1 stage (D).

Table 3 Multivariate Cox Regression Analyses of Prognostic Factors Influencing the Overall Survival of Elderly Patients with Metastatic Renal Cell Carcinoma Who Were Treated with Partial Nephrectomy. (Step 2, Follow LR)

Variable	Univariate Analyses		Multivariate Analyses
	Log-Rank (χ^2)	p-value	HR (95% CI)	p-value
Age at diagnosis	0.70	0.402	-	-
Race	4.66	0.097	-	-
Gender	0.04	0.849	-	-
Marital status	4.02	0.134	-	-
Site	0.03	0.871	-	-
Histologic type	1.12	0.290	-	-
Tumor Size	12.18	<0.001	-	-
≤7 cm	-	-	Reference	1.000
>7 cm	-	-	2.54(1.25–5.13)	0.010
Fuhrman grade	9.44	0.024	-	-
T stage	10.02	0.018	-	-
N Stage	30.78	<0.001	-	<0.001
N0	-	-	Reference	1.000
N1	-	-	5.48(2.46–12.22)	<0.001
Unknown	-	-	2.51(0.58–10.94)	0.219
Metastasis sites	5.00	0.025	-	-

Abbreviations: HR, Hazard Ratio; 95% CI, 95% Confidence Interval.

Figure 3 Risk analysis of patients undergoing cytoreductive partial nephrectomy according to tumor diameter >7cm (A) and N1 stage (B).

Figure 4 Nomogram model (A) for elderly metastatic renal cell carcinoma and calibration curve of survival probability prediction: 1-year (B), 2-year (C), 3-year (D).