Thinking beyond surgery in the management of renal cell carcinoma: The risk to die from renal cell carcinoma and competing risks of death

Introduction: The presentation of renal cell carcinoma (RCC) has changed where it is most commonly identified when asymptomatic and incidental. Contemporary patients with renal tumors are often older in age and may have significant concurrent medical comorbidity, where proceeding with routine surgical treatment may not be of benefit. Traditional clinical assessments have not considered the impact of comorbidity on oncologic outcome, and recent studies have demonstrated the relationship between comorbidity and patient survival. We review the existing data examining the significance of medical comorbidity on RCC management and outcomes. Materials and methods: The existing literature on this topic is reviewed, and validated measures of comorbidity are described. The available studies examining the relationship between comorbidity and RCC are summarized. Results and Discussion: The article reviews the growing body of literature supporting the importance of assessment of patient comorbidity, and we highlight novel prognostic instruments that can estimate the likelihood of several different patient outcomes following RCC treatment, and these nomograms can be accessed via a web-based portal (www.cancernomograms.com) to assist in patient education and clinical decision making.