Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?

Hdl Handle:
http://hdl.handle.net/10147/207494
Title:
Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?
Authors:
O'Connor, Kevin M; Davis, Niall; Lennon, Gerry M; Quinlan, David M; Mulvin, David W
Affiliation:
Department of Urology, St. Vincent's University Hospital, Dublin, Ireland., kevinoconnor@rcsi.ie
Citation:
BJU Int. 2009 Jun;103(11):1492-5. Epub 2008 Dec 8.
Journal:
BJU international
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207494
DOI:
10.1111/j.1464-410X.2008.08275.x
PubMed ID:
19076135
Abstract:
OBJECTIVE To determine the safety of surveillance for localized contrast-enhancing renal masses in elderly patients whose comorbidities precluded invasive management; to provide an insight into the natural history of small enhancing renal masses; and to aid the clinician in identifying those patients who are most suitable for a non-interventional approach. PATIENTS AND METHODS We conducted a retrospective chart review of 26 consecutive patients (16 men and 10 women), who were followed for > or =1 year, with localized solid enhancing renal masses between 1998 and 2006. These patients were unfit or unwilling to undergo radical or partial nephrectomy. None had their tumours surgically removed. Study variables included age, presentation, tumour size, growth rate, Charlson comorbidity index (CMI) and available pathological data. RESULTS The mean (range) patient age was 78.14 (63-89) year, with a mean follow-up of 28.1 (12-72) months. The mean tumour size was 4.25 (2.5-8.7) cm at diagnosis. The tumour growth rate was 0.44 cm/year; among smaller masses (T1a) it was 0.15 cm/year, vs 0.64 cm/year in the larger masses (T1b and T2). The mean CMI was 2.96. There were 11 deaths overall; 10 patients died from unrelated illnesses. One death was directly attributable to metastatic renal cancer; this patient had an initial tumour diameter of 5.4 cm and a CMI of 6. All patients who died had a CMI of > or =3. CONCLUSIONS Elderly patients with small renal tumours (T1a) and comorbidity scores of > or =3 were more likely to die as a result of their comorbidities rather than the renal tumour. Surveillance of small renal masses appears to be a safe alternative in elderly patients who are poor surgical candidates, where the overall growth rate appears to be slow.
Language:
eng
MeSH:
Aged; Aged, 80 and over; Disease Progression; Epidemiologic Methods; Female; Humans; Kidney Neoplasms/complications/*pathology/surgery; Male; Middle Aged; Neoplasm Staging; *Nephrectomy; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden
ISSN:
1464-410X (Electronic); 1464-4096 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Connor, Kevin Men_GB
dc.contributor.authorDavis, Niallen_GB
dc.contributor.authorLennon, Gerry Men_GB
dc.contributor.authorQuinlan, David Men_GB
dc.contributor.authorMulvin, David Wen_GB
dc.date.accessioned2012-02-01T10:29:25Z-
dc.date.available2012-02-01T10:29:25Z-
dc.date.issued2012-02-01T10:29:25Z-
dc.identifier.citationBJU Int. 2009 Jun;103(11):1492-5. Epub 2008 Dec 8.en_GB
dc.identifier.issn1464-410X (Electronic)en_GB
dc.identifier.issn1464-4096 (Linking)en_GB
dc.identifier.pmid19076135en_GB
dc.identifier.doi10.1111/j.1464-410X.2008.08275.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207494-
dc.description.abstractOBJECTIVE To determine the safety of surveillance for localized contrast-enhancing renal masses in elderly patients whose comorbidities precluded invasive management; to provide an insight into the natural history of small enhancing renal masses; and to aid the clinician in identifying those patients who are most suitable for a non-interventional approach. PATIENTS AND METHODS We conducted a retrospective chart review of 26 consecutive patients (16 men and 10 women), who were followed for > or =1 year, with localized solid enhancing renal masses between 1998 and 2006. These patients were unfit or unwilling to undergo radical or partial nephrectomy. None had their tumours surgically removed. Study variables included age, presentation, tumour size, growth rate, Charlson comorbidity index (CMI) and available pathological data. RESULTS The mean (range) patient age was 78.14 (63-89) year, with a mean follow-up of 28.1 (12-72) months. The mean tumour size was 4.25 (2.5-8.7) cm at diagnosis. The tumour growth rate was 0.44 cm/year; among smaller masses (T1a) it was 0.15 cm/year, vs 0.64 cm/year in the larger masses (T1b and T2). The mean CMI was 2.96. There were 11 deaths overall; 10 patients died from unrelated illnesses. One death was directly attributable to metastatic renal cancer; this patient had an initial tumour diameter of 5.4 cm and a CMI of 6. All patients who died had a CMI of > or =3. CONCLUSIONS Elderly patients with small renal tumours (T1a) and comorbidity scores of > or =3 were more likely to die as a result of their comorbidities rather than the renal tumour. Surveillance of small renal masses appears to be a safe alternative in elderly patients who are poor surgical candidates, where the overall growth rate appears to be slow.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshDisease Progressionen_GB
dc.subject.meshEpidemiologic Methodsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshKidney Neoplasms/complications/*pathology/surgeryen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNeoplasm Stagingen_GB
dc.subject.mesh*Nephrectomyen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTomography, X-Ray Computeden_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshTumor Burdenen_GB
dc.titleCan we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?en_GB
dc.contributor.departmentDepartment of Urology, St. Vincent's University Hospital, Dublin, Ireland., kevinoconnor@rcsi.ieen_GB
dc.identifier.journalBJU internationalen_GB
dc.description.provinceLeinster-

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.