Current Problems in Surgery · Nov 2026
Dynamic Trends in Treatment Patterns and Survival Disparities among Octogenarians with T1a Renal Cell Carcinoma: An Age-Stratified Cohort Study
By Zhang Y, Xie Y, Li L et al.
Background Older adults constitute the fastest-growing demographic with T1a renal cell carcinoma (RCC), yet significant survival disparities persist. This study examines age-related inequities in treatment and mortality, focusing on octogenarians (≥80 years). Methods We analyzed 29,782 patients aged ≥65 with T1a RCC from the SEER database (2004–2022), including 4,836 octogenarians. Analyses included treatment trends, cumulative incidence of death, Joinpoint regression, Cox models, and co-variate attenuation analysis. Results The rate of non-surgical management was 15.6% overall but surged to 40.1% in octogenarians, who received partial nephrectomy less frequently (16.2% vs. 50.8% in 65–69-year-olds). Octogenarians had a 4.39-fold higher mortality risk (95% CI: 4.16–4.63), with a rising trend in cancer-specific mortality (APC=3.28). In octogenarians, cardiovascular death (15.74%) slightly exceeded RCC death (14.55%) at 5 years, indicating that competing causes predominated. Exploratory co-variate adjustment analyses suggested that treatment-related factors statistically attenuated the age–mortality association. Conclusion These findings suggest that the conservative management pattern is significantly associated with observed survival disparities. While our co-variate attenuation analysis highlights a statistical link, the observational design underscores the need for cautious interpretation regarding direct causality.