Impact of Age on the Cancer-Specific Survival of Patients with Localized Renal Cell Carcinoma: Martingale Residual and Competing Risks Analysis

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.

DOI: 10.1371/journal.pone.0048489

Extracted Key Phrases

8 Figures and Tables

0204060201520162017
Citations per Year

Citation Velocity: 7

Averaging 7 citations per year over the last 3 years.

Learn more about how we calculate this metric in our FAQ.

Cite this paper

@inproceedings{Cai2012ImpactOA, title={Impact of Age on the Cancer-Specific Survival of Patients with Localized Renal Cell Carcinoma: Martingale Residual and Competing Risks Analysis}, author={Muyan Cai and Jinhuan Wei and Zhiling Zhang and Hongwei Zhao and Yunqiao Qiu and Yong Fang and Zhenli Gao and Jiazheng Cao and Wei Chen and Fangjian Zhou and Dan Xie and Junhang Luo}, booktitle={PloS one}, year={2012} }