Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?
Affiliation
Department of Urology, St. Vincent's University Hospital, Dublin, Ireland., kevinoconnor@rcsi.ieIssue Date
2012-02-01T10:29:25ZMeSH
AgedAged, 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
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BJU Int. 2009 Jun;103(11):1492-5. Epub 2008 Dec 8.Journal
BJU internationalDOI
10.1111/j.1464-410X.2008.08275.xPubMed ID
19076135Abstract
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
engISSN
1464-410X (Electronic)1464-4096 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1111/j.1464-410X.2008.08275.x
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