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Song Z, Xing J, Sun Z, Kang X, Li H, Ren G, Wang Y. Time trends in surgical provision and cancer-specific outcomes in patients with stage T2-3 kidney cancer: a SEER-based study. Front Surg 2024; 11:1370702. [PMID: 38742149 PMCID: PMC11089187 DOI: 10.3389/fsurg.2024.1370702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Background and objective Surgery is the primary therapy that crucially affects the survival of patients with kidney cancer (KC). However, pertinent surgical decision criteria for individuals with stage T2-3 KC are lacking. This study aimed to display the practical choices and evolving trends of surgical procedures and elucidate their implied value. Methods Through the Surveillance, Epidemiology, and End Results (SEER) dataset, the levels and evolving trends of different surgical methods were examined to determine cancer-specific risk of death (CSRD). Additionally, stratification analysis and survival rate analysis were performed to explore the effectiveness of partial nephrectomy (PN). Results In this study, 9.27% of patients opted for PN. Interestingly, an upward trend was observed in its decision, with an average annual percentage change (AAPC) of 7.0 (95% CI: 4.8-9.3, P < 0.05). Patients who underwent PN and were in a relatively less severe condition exhibited more favorable CSRD levels (0.17-0.36 vs. 0.50-0.67) and an improvement trend compared with those who underwent radical nephrectomy (RN) (AAPC: -1.9 vs. -0.8). Further analysis showed that the levels of CSRD and survival rates for patients opting for different surgical methods followed a similar pattern. Conclusions This study showed that RN was still the most common surgical method. Patients with stage T2-3 KC had an increasing preference for PN and exhibited more favorable cancer-related survival outcomes, which underscores the need for further investigation and validation.
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Affiliation(s)
- Zhuo Song
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jizhang Xing
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Zhijia Sun
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Xiaoli Kang
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Hongzhao Li
- Department of Urology, The General Hospital of the People’s Liberation Army, Beijing, China
| | - Gang Ren
- Department of Radiotherapy, Peking University Shougang Hospital, Beijing, China
| | - Yingjie Wang
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
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Okhawere KE, Pandav K, Grauer R, Wilson MP, Saini I, Korn TG, Meilika KN, Badani KK. Trends in the surgical management of kidney cancer by tumor stage, treatment modality, facility type, and location. J Robot Surg 2023; 17:2451-2460. [PMID: 37470910 DOI: 10.1007/s11701-023-01664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Partial nephrectomy (PN) is an alternative to radical nephrectomy (RN) in the appropriate localized renal tumor. The scope of PN has expanded over time and, since the advent and proliferation of minimally invasive surgery, more surgeons have access to and have been trained in laparoscopic and robotic technology. Amid the changing surgical landscape, we sought to characterize the trends in management by cancer stage, institution type, and geographic location using the National Cancer Database (NCDB). We queried the NCDB for patients with kidney cancer from 2004 to 2019. Overall, 241,311 patients who underwent PN or RN were included in the study. The nephrectomy approach was categorized as robotic partial (RPN), robotic radical (RRN), laparoscopic partial (LPN), laparoscopic radical (LRN), open or unspecified partial (OPN), and open or unspecified radical (ORN). The categorical variables were presented as frequency and percentages. Overall, there was an increase in the utilization of robotic approaches from 2010 to 2019. For cT1 tumors, the use of RPN and RRN increased from 14.27 to 33.06% and 5.24% to 19.63%, respectively. The use of ORN for cT2 and cT3 tumors declined, with rates dropping from 54.71 to 10.76% and 64.71 to 46.64%, respectively. Conversely, the utilization of RRN rose during this period. However, ORN remained the most common approach for cT3 tumors. The use of RPN increased across different facility types, with the highest utilization observed in academic/research programs. The use of ORN for cT2 and cT3 tumors declined across facility types, although it remained most prevalent in community cancer programs. The use of robot-assisted surgery to treat localized renal cancer increased in the US between 2010 and 2019 across all stages of disease. RPN became the most used approach for cT1 disease, while LRN was preferred for cT2 disease. ORN remained the approach of choice for cT3 disease throughout the study period. Trends in facility type and geographic location largely mirrored the overall trends.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA.
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3
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Grosso AA, Di Maida F, Tellini R, Viola L, Lambertini L, Valastro F, Mari A, Masieri L, Carini M, Minervini A. Assessing the impact of socio-economic determinants on access to care, surgical treatment options and outcomes among patients with renal mass: Insight from the universal healthcare system. Eur J Cancer Care (Engl) 2022; 31:e13666. [PMID: 35869594 PMCID: PMC9787702 DOI: 10.1111/ecc.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess whether socio-economic disparities exist on access to care, treatment options and outcomes among patients with renal mass amenable of surgical treatment within the universal healthcare system. METHODS Data of consecutive patients submitted to partial nephrectomy (PN) or radical nephrectomy (RN) at our Institution between 2017 and 2020 were retrospectively evaluated. Patients were grouped according to their income level (low, intermediate, and high) based on the Indicator of Equivalent Economic Situation national criterion. Survival analysis was performed. Cox regression models were employed to analyse the impact of socio-economic variables on survival outcomes. RESULTS One thousand forty-two patients were included (841 PN and 201 RN). Patients at the lowest income level were found more likely symptomatic and with a higher pathological tumour stage in the RN cohort (p > 0.05). The guidelines adherence on surgical indication rate as well as the access to minimally invasive surgery did not differ according to patient's income level in both cohorts (p > 0.05). Survival curves were comparable among the groups. Cox regression analysis showed that none of the included socio-economic variables was associated with survival outcomes in our series. CONCLUSIONS Universal healthcare system may increase the possibility to ensure egalitarian treatment modalities for patients with renal cancer.
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Affiliation(s)
- Antonio Andrea Grosso
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Fabrizio Di Maida
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Riccardo Tellini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Lorenzo Viola
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Luca Lambertini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Francesca Valastro
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Andrea Mari
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Lorenzo Masieri
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Marco Carini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
| | - Andrea Minervini
- Department of Experimental and Clinical MedicineUniversity of Florence ‐ Unit of Oncologic Minimally‐Invasive Urology and Andrology, Careggi HospitalFlorenceItaly
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Cruz A, Dickerson F, Pulling KR, Garcia K, Gachupin FC, Hsu CH, Chipollini J, Lee BR, Batai K. Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2050. [PMID: 35206240 PMCID: PMC8872003 DOI: 10.3390/ijerph19042050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 12/20/2022]
Abstract
Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.
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Affiliation(s)
- Alejandro Cruz
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Faith Dickerson
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Kathryn R. Pulling
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Kyle Garcia
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Francine C. Gachupin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ 85724, USA;
| | - Juan Chipollini
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Benjamin R. Lee
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
| | - Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ 85724, USA; (A.C.); (F.D.); (K.R.P.); (K.G.); (J.C.); (B.R.L.)
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5
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May AM, Guduru A, Fernelius J, Raza SJ, Davaro F, Siddiqui SA, Hamilton ZA. Current Trends in Partial Nephrectomy After Guideline Release: Health Disparity for Small Renal Mass. KIDNEY CANCER 2019. [DOI: 10.3233/kca-190066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Allison M. May
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
| | - Anirudh Guduru
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
| | - Joshua Fernelius
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
| | - Syed J. Raza
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
| | - Facundo Davaro
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
| | - Sameer A. Siddiqui
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
| | - Zachary A. Hamilton
- Department of Surgery, Division of Urology, Saint Louis University, St. Louis, MO, USA
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6
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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7
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Organ-sparing procedures in GU cancer: part 1-organ-sparing procedures in renal and adrenal tumors: a systematic review. Int Urol Nephrol 2019; 51:377-393. [PMID: 30623290 DOI: 10.1007/s11255-018-02070-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/27/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Organ-sparing surgery (OSS) for the kidney and adrenals has emerged as the need for preservation of function is paramount in patients with poor functional reserve. As reports increasingly showed that oncological outcomes were equivalent to radical excision, elective OSS became a viable alternative in patients with otherwise normal reserve. In this review, we summarize the current knowledge of OSS for adrenal and renal tumors. MATERIALS AND METHODS PubMed, Web of Science and Cochrane Library Central Search were searched for recently published articles up to December 2017. The following keywords were used; "partial adrenalectomy", "adrenal sparing", "partial nephrectomy", "nephron sparing", "kidney/renal cancer". RESULTS Partial adrenalectomy became an attractive alternative to total adrenalectomy avoiding adrenal insufficiency. Both minimally invasive surgery and ablative techniques were increasingly reported for adrenal OSS with adequate residual adrenal function and excellent oncological outcome. Radical nephrectomy remained for many years as the gold standard of treatment for organ-confined renal cell carcinoma. As the need to reduce the impact on renal function, more conservative approaches were utilized. Soon, the non-inferiority of nephron-sparing surgery to that of radical excision became evident and elective partial nephrectomy was gaining ground as the standard of care for small renal masses in patients with normal contralateral kidneys. CONCLUSIONS Herein, we present a comprehensive review of the current status of OSS in renal and adrenal tumors.
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8
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Batai K, Bergersen A, Price E, Hynes K, Ellis NA, Lee BR. Clinical and Molecular Characteristics and Burden of Kidney Cancer Among Hispanics and Native Americans: Steps Toward Precision Medicine. Clin Genitourin Cancer 2018; 16:e535-e541. [PMID: 29449090 DOI: 10.1016/j.clgc.2018.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/16/2018] [Indexed: 01/20/2023]
Abstract
Cancer disparities in Native Americans (NAs) and Hispanic Americans (HAs) vary significantly in terms of cancer incidence and mortality rates across geographic regions. This review reports that kidney and renal pelvis cancers are unevenly affecting HAs and NAs compared to European Americans of non-Hispanic origin, and that currently there is significant need for improved data and reporting to be able to advance toward genomic-based precision medicine for the assessment of such cancers in these medically underserved populations. More specifically, in states along the US-Mexico border, HAs and NAs have higher kidney cancer incidence rates as well as a higher prevalence of kidney cancer risk factors, including obesity and chronic kidney disease. They are also more likely to receive suboptimal care compared to European Americans. Furthermore, they are underrepresented in epidemiologic, clinical, and molecular genomic studies of kidney cancer. Therefore, we maintain that progress in precision medicine for kidney cancer care requires an understanding of various factors among HAs and NAs, including the real kidney cancer burden, variations in clinical care, issues related to access to care, and specific clinical and molecular characteristics.
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Affiliation(s)
- Ken Batai
- Department of Surgery, Division of Urology, University of Arizona, Tucson, AZ.
| | - Andrew Bergersen
- Department of Surgery, Division of Urology, University of Arizona, Tucson, AZ
| | - Elinora Price
- Department of Surgery, Division of Urology, University of Arizona, Tucson, AZ
| | - Kieran Hynes
- Department of Surgery, Division of Urology, University of Arizona, Tucson, AZ
| | - Nathan A Ellis
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Benjamin R Lee
- Department of Surgery, Division of Urology, University of Arizona, Tucson, AZ
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9
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Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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10
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Leppert JT, Mittakanti HR, Thomas IC, Lamberts RW, Sonn GA, Chung BI, Skinner EC, Wagner TH, Chertow GM, Brooks JD. Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind? Urology 2016; 100:65-71. [PMID: 27634733 DOI: 10.1016/j.urology.2016.08.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/17/2016] [Accepted: 08/30/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial nephrectomy in a national integrated healthcare system. MATERIALS AND METHODS We identified patients treated with a radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration. We examined associations among patient age, sex, race or ethnicity, multimorbidity, baseline kidney function, tumor characteristics, and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time. RESULTS In our cohort of 14,186 patients, 4508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002 to 32% in 2008 and to 38% in 2014. Patient race or ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, whereas older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy. CONCLUSION Although the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible.
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Affiliation(s)
- John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA.
| | | | - I-Chun Thomas
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Remy W Lamberts
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Geoffrey A Sonn
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA
| | - Todd H Wagner
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford Kidney Cancer Research Program, Stanford, CA
| | - Glenn M Chertow
- Stanford Kidney Cancer Research Program, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Stanford Kidney Cancer Research Program, Stanford, CA
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11
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Kiechle JE, Abouassaly R, Gross CP, Dong S, Cherullo EE, Zhu H, Trinh QD, Sun M, Meropol NJ, Hoimes CJ, Ialacci S, Kim SP. Racial Disparities in Partial Nephrectomy Persist Across Hospital Types: Results From a Population-based Cohort. Urology 2015; 90:69-74. [PMID: 26724412 DOI: 10.1016/j.urology.2015.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/11/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the national utilization of partial nephrectomy (PN) for T1a renal masses across different racial groups by hospital type. Although clinical guidelines recommend PN for small renal masses (SRMs), racial disparities persist in the use of PN. High-volume and academic hospitals have been associated with greater use of PN for SRMs. However, it is unknown whether racial disparities persist in the use of PN across different types of hospitals. METHODS Using the National Cancer Database, we identified patients with localized T1a renal cancer (≤4 cm) from 1998 to 2011. The primary outcome was receipt of PN among patients surgically treated for SRMs. Multivariable logistic regression analyses were used to assess for racial differences in treatment with PN stratified by hospital characteristics. RESULTS Among 118,207 patients diagnosed with clinical T1a renal masses, 36.5% underwent PN (n = 43,134). Overall, a greater proportion of white patients underwent PN (37.3%) compared with African-American (32.4%) and Hispanic (33.7%) patients with SRMs (P <.001). When stratified by hospital type, disparities persisted in the use of PN; African-American patients had lower adjusted odds ratios for being treated with PN when treated at comprehensive community cancer (odds ratio: 0.90; P = .003) and academic (odds ratio: 0.65; P <.001) hospitals compared with white patients. CONCLUSIONS In this population-based cohort, we found that racial disparities persist across all types of hospitals in the use of PN for SRMs. Further research is needed to identify, and target for intervention, the factors contributing to racial disparities in the surgical management of SRMs.
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Affiliation(s)
- Jonathan E Kiechle
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Robert Abouassaly
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Cary P Gross
- Department of Internal Medicine, Yale University, New Haven, CT; Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Shan Dong
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Edward E Cherullo
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Harvard Medical School, Boston, MA
| | | | - Neal J Meropol
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher J Hoimes
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sarah Ialacci
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Simon P Kim
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; Department of Internal Medicine, Yale University, New Haven, CT.
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12
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Meyer C, Hansen J, Becker A, Schmid M, Pradel L, Strini K, Chromecki T, Jesche-Chromecki J, Fisch M, Zigeuner R, Chun FKH. The Adoption of Nephron-Sparing Surgery in Europe - A Trend Analysis in Two Referral Centers from Austria and Germany. Urol Int 2015; 96:330-6. [PMID: 26699625 DOI: 10.1159/000442215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/04/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the trends of partial nephrectomy (PN) and radical nephrectomy (RN) in 2 European tertiary referral centers with regards to guideline changes. MATERIALS AND METHODS A total of 1,573 patients who underwent RN or PN for localized (≤T2) renal cell carcinoma (RCC) were included. Logistic regression analyses assessed the predictors of PN and laparoscopy over time. RESULTS Out of the total, 1,013 patients (65.6%) were treated with RN and 560 patients (34.4%) with PN. Also, 1,233 patients (80%) had open surgery whereas 340 patients (22%) were treated with a laparoscopic approach. Laparoscopic RN and PN were performed in 216 (13.7%) and 124 (7.8%) patients, respectively. T1b tumors were 73% less likely (p < 0.001) to be treated with PN compared to T1a tumors. The odds of undergoing PN or laparoscopy in 2008-2010 relative to 2000-2001 were 6.5-fold (p < 0.001) and 36-fold higher (p < 0.001), respectively. CONCLUSIONS Tumor size and year of surgery are independent predictors of PN in our cohort. Our data exemplify the adoption of PN for RCC in tertiary care centers in Austria and Germany in line with implemented guideline changes. The utilization of PN has increased over time regardless of surgical approach. Further studies need to address the use of robot-assisted surgery and care in community hospitals.
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Affiliation(s)
- Christian Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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Abstract
Historically, open radical nephrectomy (ORN) represented the standard of care for localized renal cell carcinoma (RCC). While the incidence of T1 RCC is rising, treatment options are developing fast and the standard of care according to European and American guidelines has changed to partial nephrectomy (PN), or laparoscopic radical nephrectomy in patients not suitable for PN. To assess the implementation of guideline recommendations and to profile recent surgical and technical innovations, we reviewed the current literature. We observed that ORN still represents the most commonly used treatment in T1 RCC patients. Utilization of PN increased over time but implementation is still in progress. Whereas PN is frequently used in tertiary care centers, population-based studies suggest discrepancies in the diffusion of standard of care treatments. Alternative minimally invasive approaches for PN are available but their superiority is not yet proven. Further efforts in improving the training of urologic surgeons are required to continue the implementation of guideline recommendations.
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Affiliation(s)
- Jonas Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Vaishampayan U, Vankayala H, Vigneau FD, Quarshie W, Dickow B, Chalasani S, Schwartz K. The effect of targeted therapy on overall survival in advanced renal cancer: a study of the national surveillance epidemiology and end results registry database. Clin Genitourin Cancer 2013; 12:124-9. [PMID: 24225251 DOI: 10.1016/j.clgc.2013.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/05/2013] [Accepted: 09/24/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION With the advent and availability of targeted therapy, the treatment of advanced/metastatic renal cell carcinoma (RCC) underwent a drastic change in 2005. The effect of this change on clinical outcome within the population has not been studied. The aim of this study was to evaluate the overall survival (OS), before, and after availability of targeted therapy, for advanced RCC cases in the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry. MATERIALS AND METHODS All advanced (regional and distant stage) RCC cases diagnosed within the 2000 to 2008 time periods were included. Because SEER does not report the exact therapy, and because targeted therapy was initially approved in 2005, we evaluated and compared the OS outcomes of advanced RCC cases diagnosed between the years 2000 and 2003 (before targeted therapy era) with that of those diagnosed between 2005 and 2008 (targeted therapy era). RESULTS There was a significant improvement in OS for advanced RCC patients treated in the targeted therapy era (n = 12,330) compared with those treated in the era before targeted therapy (n =11,565) (median OS 20 months vs. 15 months, P = .0006). Multivariate analysis revealed that in the time period before targeted therapy, age older than 65 years, black race, and lack of nephrectomy were predictors of a shorter OS. CONCLUSION In univariate and multivariate analysis, targeted therapy demonstrated improvement in OS. Increasing access to targeted therapies is likely to improve outcomes in advanced RCC.
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Affiliation(s)
| | - Hema Vankayala
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Fawn D Vigneau
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | - Brenda Dickow
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | - Kendra Schwartz
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
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15
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Becker A, Roghmann F, Trinh QD, Hansen J, Tian Z, Shariat SF, Noldus J, Perrotte P, Graefen M, Karakiewicz PI, Sun M. Sociodemographic disparities in the treatment of small renal masses. BJU Int 2013; 111:E274-82. [PMID: 23714645 DOI: 10.1111/bju.12111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the presence of specific sociodemographic disparities in the treatment of individuals with small renal masses. PATIENTS AND METHODS Patients diagnosed with pT1aN0M0 renal cell carcinoma (RCC) were identified from the Surveillance, Epidemiology, and End Results database (years 1988-2008). Treatment type was stratified into non-surgical and surgical management and the group of patients who underwent surgical intervention was further stratified into those who underwent partial nephrectomy (PN) and those who underwent radical nephrectomy (RN). The main variables of interest were race and gender, as well as family income and poverty and education levels. Temporal trend analyses and logistic regression models were performed. RESULTS Of 26,468 patients with T1aN0M0 RCC, 2797 (10.6%) were non-surgically managed and 23,671 (89.4%) underwent surgery. Of the latter, 14,705 (62.1%) underwent RN and 8966 (37.9%) PN. In multivariable analyses, black patients were 23% more likely to be non-surgically managed than other ethnic groups, and if surgically managed, were 20% less likely to undergo PN (both P ≤ 0.007). Men were 19% more likely than women to be non-surgically managed, but remained 14% more likely to receive a PN (both P < 0.001). Treatment disparities according to income, education and poverty level were recorded. Poverty (odds ratio [OR]: 1.002) and education (OR: 0.998) proxies emerged as important determinants of non-surgical management, whereas income (OR: 1.08, all P ≤ 0.02) was a determinant of PN. CONCLUSIONS Social inequalities regarding access to treatment remain prevalent among patients diagnosed with small renal masses. The persistence of such a phenomenon is a concerning trend which merits further investigation.
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Affiliation(s)
- Andreas Becker
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
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