Skip to main content

Advertisement

Log in

Renal Cancer in the Elderly

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The increase of the aging population corresponds with the rise of renal cancer in elderly patients. The distinction between functional and chronological age, quality of life, and survival estimate are important issues, among others, that should be considered in the management of renal cancer in elderly patients. We made this review with the purpose of synthesizing the most updated criteria regarding indications and outcomes of the different therapeutic options in the management of elderly patients with renal cancer, beginning from the physiologic considerations that characterize them, their capacity to tolerate different therapeutic possibilities, and the prognosis of the patients’ risks and comorbidity assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance,•• Of major importance

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

    Article  PubMed  Google Scholar 

  2. Ljungberg B, Campbell SC, Choi HY, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60(4):615–21.

    Article  PubMed  Google Scholar 

  3. Quivy A, Daste A, Harbaoui A, et al. Optimal management of renal cell carcinoma in the elderly: a review. Clin Interv Aging. 2013;8:433–42.

    PubMed  PubMed Central  Google Scholar 

  4. Bellmunt J, Puente J, Garcia de Muro J, Lainez N, Rodríguez C, Duran Iet al. SEOM clinical guidelines for the treatment of renal cell carcinoma. Clin Transl Oncol. 2014; 16(12):1043–50.

  5. Eltahawy E, Kamel M, Ezzet M. Management of renal cell carcinoma presenting as inflammatory renal mass. Urol Ann. 2015;7(3):330–33.

    PubMed  PubMed Central  Google Scholar 

  6. Kutikov A, Egleston BL, Wong YN, Uzzo RG. Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram. J Clin Oncol. 2010;28(2):311–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Vira MA, Steckel J. Core principle of perioperative care. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Editors. Campbell-Walsh Urology.10 ed. Philadelphia; 2012. p. 159–176.

  8. Lin Q, Wagner W. Epigenetic aging signatures are coherently modified in cancer. PLoS Genet. 2015;11(6), e1005334.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hubbard JM, Cohen HJ, Muss HB. Incorporating biomarkers into cancer and aging research. JCO. 2014;32(24):2611–16.

    Article  Google Scholar 

  10. Brassart E, Lebdai S, Berger J, et al. Overall mortality after radical nephrectomy in patients aged over 80 years with renal cancer: a retrospective study on preoperative prognostic factors. Int J Urol. 2012;19(7):626–32.

    Article  PubMed  Google Scholar 

  11. Repetto L, Audisio A. Elderly patients have become the leading drug consumers: it’s high time to properly evaluate new drugs within the real targeted population. J Clin Oncol. 2006;24(35):62–3.

    Article  Google Scholar 

  12. Rajer, M. Treatment of renal cell carcinoma in elderly and frail patients. INTECH Open Access Publisher, 2012. http://cdn.intechopen.com/pdfs-wm/27646.pdf.

  13. Lane BR, Abouassaly R, Gao T, et al. Active treatment of localized renal tumours may not impact overall survival in patients aged 75 years or older. Cancer. 2010;116(13):3119–26. This paper is an interesting study. Although their study design has several limitations, the author observed that active treatment was not associated with improved overall survival relative to active surveillance in a heterogeneous population of patients aged ≥75 years who had clinically localized renal cancer.

    Article  PubMed  Google Scholar 

  14. Owusu C, Berger NA. Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care. Clin Pract (Lond). 2014;11(6):749–62.

    Article  CAS  Google Scholar 

  15. Griffiths R, Beech F, Brown A, et al. Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2014;69 Suppl 1:81–98.

    PubMed  Google Scholar 

  16. McKibben MJ, Smith AB. Evaluation and management of the geriatric urologic oncology patient. Curr Geriatr Rep. 2015;4(1):7–15.

    Article  PubMed  Google Scholar 

  17. Badgwell B, Stanley J, Chang GJ, et al. Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. J Surg Oncol. 2013;108(3):182–6.

    Article  PubMed  Google Scholar 

  18. Zekry D, Loures Valle BH, Lardi C, et al. Geriatrics index of comorbidity was the most accurate predictor of death in geriatric hospital among six comorbidity scores. J Clin Epidemiol. 2010;63(9):1036–44.

    Article  PubMed  Google Scholar 

  19. Beloosesky Y, Weiss A, Mansur N. Validity of the medication-based disease burden index compared with the Charlson comorbidity index and the cumulative illness rating scale for geriatrics: a cohort study. Drugs Aging. 2011;28(12):1007–14.

    Article  PubMed  Google Scholar 

  20. Abizanda Soler P, Paterna Mellinas G, Martínez Sánchez E, López Jiménez E. Comorbidity in the elderly: utility and validity of assessment tools. Rev Esp Geriatr Gerontol. 2010;45(4):219–28.

    Article  PubMed  Google Scholar 

  21. Ito T, Abbosh PH, Mehrazin R, et al. Surgical Apgar Score predicts an increased risk of major complications and death after renal mass excision. J Urol. 2015;193(6):1918–22.

    Article  PubMed  Google Scholar 

  22. Jering MZ, Marolen KN, Shotwell MS, Denton JN, Sandberg WS, Ehrenfeld JM. Combining the ASA physical classification system and continuous intraoperative Surgical Apgar Score measurement in predicting postoperative risk. J Med Syst. 2015;39(11):147.

    Article  PubMed  Google Scholar 

  23. Lascano D, Pak JS, Kates M, et al. Validation of a frailty index in patients undergoing curative surgery for urologic malignancy and comparison with other risk stratification tools. Urol Oncol. 2015;33(10):426.

    Article  Google Scholar 

  24. Revenig LM, Canter DJ, Taylor MD, et al. Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg. 2013;217(4):665–70.

    Article  PubMed  Google Scholar 

  25. McKibben MJ, Smith AB. Evaluation and management of the geriatric urologic oncology patient. Curr Geriatr Rep. 2015;4(1):7–15.

    Article  PubMed  Google Scholar 

  26. Lane BR, Campbell SC, Demirjian S, Fergany AF. Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease. J Urol. 2013;189:1649–55.

    Article  PubMed  Google Scholar 

  27. Jewett MA, Mattar K, Basiuk J, et al. Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol. 2011;60(1):39–44. This is the first multicenter prospective phase 2 clinical trial of active surveillance of SRMs in 178 elderly and/or infirm patients to correlate growth with histology.

    Article  PubMed  Google Scholar 

  28. Escudier B, Porta C, Schmidinger M, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:49–56.

    Article  Google Scholar 

  29. Gontero P, Joniau S, Oderda M, et al. Active surveillance for small renal tumors: have clinical concerns been addressed so far? Int J Urol. 2013;20(4):356–61.

    Article  PubMed  Google Scholar 

  30. Lane B, Campbell SC. Is radical nephrectomy overused in elderly kidney cancer patients? Aging Health. 2010;6(5):587–9.

    Article  Google Scholar 

  31. Tomaszewski JJ, Uzzo RG, Kutikov A, et al. Assessing the burden of complications after surgery for clinically localized kidney cancer by age and comorbidity status. Urology. 2014;83(4):843–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. May M, Cindolo L, Zigeuner R, et al. Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life. Urol Oncol. 2014;32(8):1252–8.

    Article  PubMed  Google Scholar 

  33. Stang A, Büchel C. Renal surgery for kidney cancer in Germany 2005–2006: length of stay, risk of postoperative complications and in-hospital death. BMC Urol. 2014;12(14):74.

    Article  Google Scholar 

  34. Tomaszewski JJ, Kutikov A. Small renal mass management in the elderly and the calibration of risk. Urol Oncol. 2015;33(5):197–200.

    Article  PubMed  Google Scholar 

  35. Brassart E, Lebdai S, Berger J, et al. Overall mortality after radical nephrectomy in patients aged over 80 years with renal cancer: a retrospective study on preoperative prognostic factors. Int J Urol. 2012;19(7):626–32.

    Article  PubMed  Google Scholar 

  36. Borghesi M, Brunocilla E, Volpe A, et al. Active surveillance for clinically localized renal tumors: an updated review of current indications and clinical outcomes. Int J Urol. 2015;22(5):432–8.

    Article  PubMed  Google Scholar 

  37. Huang WC, Pinheiro LC, William PR, Lowrance T, Elkin EB. Surveillance for the management of small renal masses: utilization and outcomes in a population-based cohort. J Clin Oncol. 2013;31(6_suppl):343. This paper showed that for older patients with SRM, surveillance does not appear to adversely affect kidney cancer-specific survival, while surgery may be associated with CV complications and an increased risk of death from any cause.

    Google Scholar 

  38. Jewett M, Rendon R, Lacombe L, et al. Canadian guidelines for the management of small renal masses (SRM). Can Urol Assoc J. 2015;9(5–6):160–3.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Jacobs BL, Tan HJ, Montgomery JS, et al. Understanding criteria for surveillance of patients with a small renal mass. Urology. 2012;79:1027–32.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Eu Chang H, Ho Song Y, Dong Deuk K. Small renal masses: surgery or surveillance. Korean J Urol. 2013;54:283–8.

    Article  Google Scholar 

  41. Zhang L, Li XS, Zhou LQ. Natural history of small renal masses. Chin Med J. 2015;128:1232–7.

    Article  PubMed  Google Scholar 

  42. Yang G, Villalta JD, Meng MV, Whitson JM. Evolving practice patterns for the management of small renal masses in the USA. BJU Int. 2012;110(8):1156–61.

    Article  PubMed  Google Scholar 

  43. Chiu Y, Chiu AW. Renal preservation therapy for renal cell carcinoma. Int J Surg Oncol. 2012;2012:123596.

    PubMed  PubMed Central  Google Scholar 

  44. Penticuff JC, Kyprianou N. Therapeutic challenges in renal cell carcinoma. Am J Clin Exp Urol. 2015;3(2):77–90.

    PubMed  PubMed Central  Google Scholar 

  45. Kim EH, Tanagho YS, Saad NE, Bhayani SB, Figenshau RS. Comparison of laparoscopic and percutaneous cryoablation for treatment of renal masses. Urology. 2014;83(5):1081–7.

    Article  PubMed  Google Scholar 

  46. Wang S, Qin C, Peng Z, et al. Radiofrequency ablation versus partial nephrectomy for the treatment of clinical stage 1 renal masses: a systematic review and meta-analysis. Chin Med J (Engl). 2014;127(13):2497–503. This is a systematic review and meta-analysis of The US National Library of Medicine’s life science database (Medline) and the Web of Science about Clinical stage 1 SRMs that were treated with PN or RFA. The authors demonstrated that RFA compared with PN has a greater risk of local tumor progression but a lower major complication rate and recommended RFA as the best option for selected patients with significant comorbidity.

    Google Scholar 

  47. Schmitges J, Trinh QD, Sun M, Hansen J, Bianchi M, Jeldres C. Higher perioperative morbidity and in-hospital mortality in patients with end-stage renal disease undergoing nephrectomy for non-metastatic kidney cancer: a population-based analysis. BJU Int. 2012;110(6 Pt B):E183–90.

    Article  PubMed  Google Scholar 

  48. Larcher A, Fossati N, Tian Z, Boehm K, Meskawi M, Valdivieso R et al. Prediction of complications following partial nephrectomy: implications for ablative techniques candidates. Eur Urol. 2015. Jul 20. pii: S0302-2838(15)00607-7. Authors assessed 2476 patients in the Surveillance Epidemiology and End Results-Medicare database and showed the benefits of local tumor ablation in elderly patients compared to partial nephrectomy for kidney cancer.

  49. Kim SP, Leibovich BC, Shah ND, et al. The relationship of postoperative complications with in-hospital outcomes and costs after renal surgery for kidney cancer. BJU Int. 2013;111(4):580–8.

    Article  PubMed  Google Scholar 

  50. Roos FC, Hampel C, Thüroff JW. Renal cancer surgery in the elderly. Curr Opin Urol. 2009;19(5):459–64.

    Article  PubMed  Google Scholar 

  51. Mir MC, Ercole C, Takagi T, et al. Decline in renal function after partial nephrectomy: etiology and prevention. J Urol. 2015;193(6):1889–98.

    Article  PubMed  Google Scholar 

  52. Qi J, Yu Y, Huang T, et al. Predictors of postoperative renal functional damage after nephron-sparing surgery. World J Surg Oncol. 2013;11:216.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Chung JS, Son NH, Lee SE, et al. Overall survival and renal function after partial and radical nephrectomy among older patients with localised renal cell carcinoma: a propensity-matched multicenter study. Eur J Cancer. 2015;51(4):489–97. This is a multicenter study about PN in elderly patients. It concluded that PN does not give the benefit of higher survival rate in this population.

    Article  PubMed  Google Scholar 

  54. Shuch B, Hanley JM, Lai JC, et al. Adverse health outcomes associated with surgical management of the small renal mass. J Urol. 2014;191(2):301–8.

    Article  PubMed  Google Scholar 

  55. Kyung YS, You D, Kwon T, et al. The type of nephrectomy has little effect on overall survival or cardiac events in patients of 70 years and older with localized clinical t1 stage renal masses. Korean J Urol. 2014;55(7):446–52.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Maricić A, Sotosek S, Markić D, et al. Surgical treatment of kidney cancer in elderly. Coll Antropol. 2014;38(4):1225–7.

    PubMed  Google Scholar 

  57. Lai FC, Kau EL, Ng CS, Fuchs GJ. Laparoscopic nephrectomy outcomes of elderly patients in the 21st century. J Endourol. 2007;21(11):1309–13.

    Article  PubMed  Google Scholar 

  58. Kluth LA, Xylinas E, Shariat SF. Words of wisdom: re: a prospective, randomised EORTC intergroup phase 3 study comparing the oncological outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2013;63(2):399–400. This is one of the articles that discuss the important results of randomized EORTC intergroup phase 3 studies.

    Article  PubMed  Google Scholar 

  59. Choi YS, Park YH, Kim YJ, Kang SH, Byun SS, Hong SH. Predictive factors for the development of chronic renal insufficiency after renal surgery: a multicenter study. Int Urol Nephrol. 2014;46(4):681–6.

    Article  PubMed  CAS  Google Scholar 

  60. Abouassaly R, Alibhai SM, Tomlinson GA, Urbach DR, Finelli A. The effect of age on the morbidity of kidney surgery. J Urol. 2011;186(3):811–6.

    Article  PubMed  Google Scholar 

  61. Sun M, Trinh QD, Bianchi M, et al. A non-cancer-related survival benefit is associated with partial nephrectomy. Eur Urol. 2012;61(4):725–31. It is a discussion study which used Surveillance Epidemiology and End Results-Medicare-linked database and compared RN and PN in patients with T1a RCC to conclude that RN-treated patients are more likely to die of OCM after surgery and PN should be offered whenever technically feasible.

    Article  PubMed  Google Scholar 

  62. O'Malley RL, Hayn MH, Hellenthal NJ, Kim HL, Underwood 3rd W, Schwaab T. Safety and outcomes of surgical treatment of renal cell carcinoma in the elderly. Can J Urol. 2012;19(1):6111–7.

    PubMed  Google Scholar 

  63. Wang L, Williamson SR, Wang M, et al. Molecular subtyping of metastatic renal cell carcinoma: implications for targeted therapy. Mol Cancer. 2014;13:39.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Lee-Ying R, Lester R, Heng D. Current management and future perspectives of metastatic renal cell carcinoma. Int J Urol. 2014;21(9):847–55.

    Article  PubMed  CAS  Google Scholar 

  65. Syrios J, Kechagias G, Tsavaris N. Treatment of patients with metastatic renal cell carcinoma undergoing hemodialysis: case report of two patients and short literature review. BMC Nephrol. 2013;12(14):84.

    Article  Google Scholar 

  66. Iacovelli R, Alesini D, Palazzo A, et al. Targeted therapies and complete responses in first line treatment of metastatic renal cell carcinoma. A meta-analysis of published trials. Cancer Treat Rev. 2014;40(2):271–5. This is a meta-analysis about the incidence of complete response in patients treated with AAs for first-line therapy in metastatic RCC. The authors report that they did not increase the curative rate of metastatic disease, and complete response is a rare event in metastatic kidney tumor, even if AAs reports greater efficacy in terms of progression-free survival and of overall response rate and they suggest there are some biological factors other than angiogenesis which may influence the complete response in RCC.

    Article  PubMed  CAS  Google Scholar 

  67. Zhao B, Grivas PD. Contemporary systemic therapy for urologic malignancies in geriatric patients. Clin Geriatr Med. 2015;31(4):645–65.

    Article  PubMed  Google Scholar 

  68. Ashinuma H, Sekine I. Targeted therapy for solid tumors in the elderly. Nihon Rinsho. 2015;73(8):1419–24.

    PubMed  Google Scholar 

  69. Boehm S, Rothermundt C, Hess D, Joerger M. Antiangiogenic drugs in oncology: a focus on drug safety and the elderly—a mini-review. Gerontology. 2010;56(3):303–9.

    Article  PubMed  CAS  Google Scholar 

  70. Zustovich F, Novara G. Advanced kidney cancer: treating the elderly. Expert Rev Anticancer Ther. 2013;13(12):1389–98.

    Article  PubMed  CAS  Google Scholar 

  71. Escudier B, Albiges L, Sonpavde G. Optimal management of metastatic renal cell carcinoma: current status. Drugs. 2013;73(5):427–38.

    Article  PubMed  CAS  Google Scholar 

  72. Boehm S, Rothermundt C, Hess D, Joerger M. Antiangiogenic drugs in oncology: a focus on drug safety and the elderly—a mini-review. Gerontology. 2010;56(3):303–9.

    Article  PubMed  CAS  Google Scholar 

  73. Boyle H, Négrier S. Treatment of metastatic kidney cancer in the elderly. In: Droz J-P, Audisio RA, editors. Management of urological cancers in older people. London: Springer; 2013. p. 287–99.

    Chapter  Google Scholar 

  74. Verzoni E, de Braud F, Fabiani F, Grassi P, Testa I, Procopio G. Patient approach in advanced/metastatic renal cell carcinoma: focus on the elderly population and treatment-related toxicity. Future Oncol. 2013;9(11):1599–607.

    Article  PubMed  CAS  Google Scholar 

  75. Bellmunt J, Négrier S, Escudier B, Awada A, Aapro M, SIOG Taskforce. The medical treatment of metastatic renal cell cancer in the elderly: position paper of a SIOG Taskforce. Crit Rev Oncol Hematol. 2009;69(1):64–72. This paper represents the first systematic review of the role of targeted agents specifically in the elderly population.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tania González León.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Kidney Diseases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

González León, T., Morera Pérez, M. Renal Cancer in the Elderly. Curr Urol Rep 17, 6 (2016). https://doi.org/10.1007/s11934-015-0562-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-015-0562-2

Keywords

Navigation