The incidence of T1a renal cell carcinoma tumours has risen sharply in recent years due to increased imaging, especially in people aged 80 and older. Treatment has shifted towards a more conservative approach in all age groups. In advanced renal cancer, younger patients and those aged 70–79 are increasingly being treated with modern systemic therapy, while this proportion has hardly increased among those aged 80 and older. Survival has improved over time, especially in younger age groups. Among patients aged 80 and older, the survival gain was minimal.
This national study included 31,591 Dutch patients with newly diagnosed renal cell carcinoma (RCC) between 2011 and 2022 and examined trends in incidence, treatment and survival among those aged <70, 70–79 and ≥80. The proportion of patients aged 70 years and older increased over time from 42% to 48%. The incidence of T1a tumours increased in all age groups, most strongly among those aged 80 years and older, probably due to increased imaging.
At the same time, the treatment of T1a RCC has shifted from mainly surgery and focal therapies (such as cryotherapy or radiofrequency ablation) to a more conservative approach (‘active surveillance’/’watchful waiting’).
In the period 2019–2022, this policy was applied to 83% of patients over the age of 80, compared to 43% of patients in their seventies and 19% of younger patients. Even in the case of larger tumours (T1b–T3), a significant proportion of the oldest patients were treated conservatively, even though guidelines actually recommend surgery.
In patients with advanced RCC, systemic therapy was used more often in younger patients and those aged 70. Patients aged 80 and older, on the other hand, often received “best supportive care”, aimed at alleviating symptoms.
Over time, survival improved, partly due to modern systemic therapy for advanced RCC.
However, no clear improvement in survival was seen in patients aged 80 or older with advanced RCC. These findings point to significant differences in treatment and outcome, with the oldest patients potentially benefiting less from modern therapies.
As life expectancy increases and many older people remain fit for longer, it is important that treatment choices are based not on calendar age but primarily on individual factors (comorbidities, frailty and preferences).