Prognostic Factors Influencing Survival Outcomes in Renal Cell Carcinoma Patients Aged ≥75 Years: A Single-Center Retrospective Cohort Analysis

Objectives Mortality rates for renal cell carcinoma (RCC) are significantly higher among elderly patients than among younger populations. Comorbidities have a substantial influence on the overall prognosis of elderly individuals undergoing RCC treatment. The aim of this study is to identify prognostic factors specific to older adults with RCC. Methods This retrospective study enrolled consecutive patients aged 75 years or over with histologically confirmed RCC who were treated at Peking University Third Hospital between January 2012 and December 2024. All participants underwent partial or radical nephrectomy, performed by urological oncology specialists. Adjuvant therapy was administered according to contemporary clinical guidelines. Comprehensive clinicopathological data were systematically collected, including tumor stage (AJCC 8th edition) and histological subtype. Comorbidity burden was objectively assessed using the Charlson Comorbidity Index (CCI), with scores calculated according to standard weighting algorithms. The primary endpoint of the study was all-cause mortality, with follow-up conducted until the end of December 2024. Results This study analyzed 176 consecutive RCC patients aged 75 years or over (median age 78 years, range 75–87 years), comprising 115 males (65.3%) and 61 females (34.7%). Comorbidities were prevalent, with 61.6% of patients having hypertension and a median CCI score of 1 (range 0–7). During a median follow-up period of 44 months, there were 37 deaths (21.0% mortality), including 25 cancer-specific deaths (14.2%) and 12 non-oncological deaths (6.8%). Notably, the 80–87 age subgroup demonstrated significantly lower RCC-associated mortality (p = 0.029). Survival rates were 97.3% in one year, 90.4% in three years and 75.2% in five years. CCI ≥ 3, symptoms, tumor diameter > 4 cm, distant metastasis, Clavien ≥ 3 and AJCC stage independently predicted poorer overall survival in geriatric RCC patients. A nomogram with a C-index of 0.774 (95% CI: 0.712–0.835) was subsequently developed, demonstrating good discriminative ability. Conclusions Elderly patients with RCC can still benefit from surgery, and the prognosis is influenced by tumor biology and comorbidities. Partial nephrectomy may be considered on a case-by-case basis for patients over 80 years of age who have limited renal cancer combined with multiple comorbidities.