Serious infection may improve survival in renal cell carcinoma
Perioperative infection following nephrectomy appears to improve cancer-specific survival in patients with T2 (≥7 cm) renal cell carcinoma, according to a recent study.
Researchers conducted a retrospective cohort study using Surveillance, Epidemiology and End Results (SEER)-Medicare claims data from 2004 to 2011. They also used International Classification of Diseases (ICD)-9 and Current Procedural Terminology (CPT) codes to identify patients >65 years who underwent radical or partial nephrectomy for renal cell carcinoma.
Those hospitalized for infection within 30 days of surgery were identified. Patients who died within 90 days of surgery, had immunodeficiency and metastatic disease at diagnosis were not included.
Researchers used Kaplan-Meier curves to assess cancer-specific survival between infection and no infection groups. A Cox proportional hazards models was developed to evaluate survival while controlling for age, gender, race, Elixhauser index, tumour grade, tumour size, histological subtype, American Joint Committee on Cancer stage, systemic therapy and geographic region.
A total of 8,967 patients were identified. Of these, 493 (5.5 percent; median age 74 years; mean Elixhauser index, 4.9) were hospitalized for infection after nephrectomy, with a follow-up of 42 months.
Univariable Cox regression revealed a nonsignificant improvement in cancer-specific survival in patients with a serious infection requiring hospitalization following nephrectomy (hazard ratio [HR], 0.84; 95 percent CI, 0.69 to 1.00; p=0.054). In Cox multivariable regression, there was a significant improvement in cancer-specific survival for the same population (HR, 0.75; 0.57 to 0.99; p=0.04).
Such improvement was seen only in patients with larger (≥7 cm) tumours (HR, 0.67; 0.44 to 0.99; p=0.049). There was no impact found among patients with smaller (<7 cm) tumours (HR, 0.82; 0.57 to 1.19; p=0.3).