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Impact of Age on the Cancer-Specific Survival of Patients with Localized Renal Cell Carcinoma: Martingale Residual and Competing Risks Analysis
- Source :
- PLoS ONE, Vol 7, Iss 10, p e48489 (2012), PLoS ONE
- Publication Year :
- 2012
- Publisher :
- Public Library of Science (PLoS), 2012.
-
Abstract
- Background Age at diagnosis has been shown to be an independent prognostic factor of localized renal cell carcinoma (RCC) in several studies. We used contemporary statistical methods to reevaluate the effect of age on the cancer-specific survival (CSS) of localized RCC. Methods and findings 1,147 patients with localized RCC who underwent radical nephrectomy between 1993 and 2009 were identified in our four institutions. The association between age and CSS was estimated, and the potential threshold was identified by a univariate Cox model and by martingale residual analysis. Competing risks regression was used to identify the independent impact of age on CSS. The median age was 52 years (range, 19-84 years). The median follow-up was 61 months (range, 6-144 months) for survivors. A steep increasing smoothed martingale residual plot indicated an adverse prognostic effect of age on CSS. The age cut-off of 45 years was most predictive of CSS on univariate Cox analysis and martingale residual analysis (p = 0.005). Age ≤45 years was independently associated with a higher CSS rate in the multivariate Cox regression model (HR = 1.59, 95% CI = 1.05-2.40, p = 0.027) as well as in competing risks regression (HR = 3.60, 95% CI = 1.93-6.71, p = 0.001). Conclusions Increasing age was associated with a higher incidence of cancer-specific mortality of localized RCC. Age dichotomized at 45 years would maximize the predictive value of age on CSS, and independently predict the CSS of patients with localized RCC.
- Subjects :
- Adult
Male
Oncology
medicine.medical_specialty
Multivariate statistics
Clinical Research Design
Urology
medicine.medical_treatment
lcsh:Medicine
Young Adult
Renal cell carcinoma
Internal medicine
Genitourinary Cancers
otorhinolaryngologic diseases
Carcinoma
Humans
Medicine
Statistical Methods
Young adult
lcsh:Science
Carcinoma, Renal Cell
Survival analysis
Aged
Neoplasm Staging
Proportional Hazards Models
Aged, 80 and over
Multidisciplinary
business.industry
Proportional hazards model
Incidence (epidemiology)
lcsh:R
Age Factors
Middle Aged
medicine.disease
Survival Analysis
Kidney Neoplasms
Nephrectomy
Surgery
Female
lcsh:Q
Neoplasm Grading
business
Research Article
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....62afb5cbc7bdc8852e000329540ec851