Long-term survival after nephrectomy in older patients with non-metastatic renal cell carcinoma: a retrospective cohort study using different age cutoffs

Long-term outcomes following nephrectomy in older patients with renal cell carcinoma (RCC) remain underexplored, and age thresholds for defining “older adults” vary, commonly using ≥ 65 or ≥ 70 years. This study evaluated long-term survival outcomes following nephrectomy in older adults with non-metastatic RCC using both cutoffs. We retrospectively analyzed a single-center cohort of 891 patients with stage I–III RCC who underwent radical or partial nephrectomy between 1981 and 2018. Patients were categorized into younger and older groups using two age cutoffs: < 65 years ( n = 545) vs. ≥ 65 years ( n = 346), and < 70 years ( n = 677) vs. ≥ 70 years ( n = 214). Propensity score matching was used to create comparable cohorts. Recurrence-free survival (RFS), cancer-specific survival (CSS), overall survival (OS), and other-cause mortality (OCM) were compared between age groups. Using the ≥ 65 years cutoff, older patients had significantly shorter RFS, CSS, and OS, and higher OCM, with OS and OCM differences being more pronounced ( P < 0.001). With the ≥ 70 years cutoff, older patients had significantly shorter OS; trends toward shorter RFS and CSS were also observed, though not statistically significant. Older patients with non-metastatic RCC undergoing nephrectomy had significantly shorter OS than younger patients, regardless of whether the age cutoff was ≥ 65 or ≥ 70 years. Differences in RFS and CSS were smaller than in OS across both cutoffs, suggesting that comorbidities and age-related factors may impact long-term survival more than cancer recurrence.