Impact of Comorbidity on Overall Survival in Patients Surgically Treated for Renal Cell Carcinoma

Abstract

Objectives-While the classification of cancer has traditionally focused on gross and microscopic characteristics of the tumor, overall health of a patient can impact survival. Since patients with renal cell carcinoma (RCC) often have other medical conditions, we explored the impact of preexisting medical disease on survival following radical and partial nephrectomy. Results-The median follow-up was 32.2 months for survivors and 36.5 months for all patients. OS rate at 1, 3, and 5 years was 92.0% (641 patients), 75.3% (525 patients) and 52.7% (367 patients). Univariate analyses demonstrated that age, comorbidity, tumor size, Fuhrman grade, and pathologic stage were significant predictors of OS. Multivariate analysis revealed that age (HR 1.42, 95% CI 1.10-1.82, p=0.0067), comorbidity (HR 1.37, 95% CI 1.16-1.63, p=0.0002), pathologic stage (HR 1.97, 95% CI 1.60-2.41, p<0.0001) and grade (HR 1.83, 95% CI 1.28-2.59, p=0.0008) predicted OS. Methods-BetweenConclusions-This study demonstrates that comorbidity is an independent prognostic factor for OS in RCC patients. Capturing comorbidity information using validated instruments can improve the preoperative evaluation of patients by providing more accurate prognostic information.

The role of active surveillance of small renal masses

“…(45) An estimate of the risk of competing cause mortality can be useful in order to decide the most appropriate treatment for patients with renal cancer. This can be easily obtained with the use of specific nomograms.…”

The complex health profile of long-term cancer survivors: prevalence and predictors of comorbid conditions

“…The presence and severity of comorbidities is one of the strongest predictors of early mortality among cancer survivors [3][4][5][6][7], along with lower levels of physical functioning [8] and poorer health-related quality of life [9][10][11]. Thus, understanding the complex health profile of adult cancer survivors is essential to assess their risk of negative post-treatment outcomes, assess long-term or late effects during post-treatment follow-up visits, and to develop a plan to optimize overall health and wellbeing after cancer.…”

Use of the American Society of Anesthesiologists Classification as an Additional Planning Tool for Renal Cell Carcinoma Assessment

“…However, these prognostic factors alone cannot accurately differentiate tumors of low malignant potential from clinically relevant tumors. Thus, with an aging population and the gradual increase in chronic diseases, interest in the study of the prognostic value of comorbidities in patients with various tumors has increased [23].…”