Treatment Trends for Stage I Renal Cell Carcinoma

Abstract

Purpose: Renal cell carcinoma is increasingly diagnosed at stage I, and among stage I cases mean tumor size has been decreasing. Previous reports suggest that nephron sparing surgery is underused for small renal cell carcinomas. We determined updated, population based treatment trends for stage I renal cell carcinoma. Materials and Methods:The National Cancer Data Base, which captures approximately 70% of all cancer diagnoses in the United States, was queried for renal cell carcinoma in adults diagnosed between 1993 and 2007. Trends in treatment, including no surgery, total nephrectomy, partial nephrectomy and focal ablation, were analyzed among all stage I tumors and small stage I tumors categorized by size. Logistic regression was used to identify predictors of nephron sparing surgery (partial nephrectomy or focal ablation). Results: During the study period we identified 242,740 renal cell carcinomas, of which 127,691 were stage I. For all stage I tumors partial nephrectomy increased from 6.3% to 32.2% of cases and ablation increased from 1.0% to 6.8%. For tumors less than 2.0, 2.0 to 2.9 and 3.0 to 3.9 cm partial nephrectomy increased from 15.3% to 61.1%, 11.0% to 44.2% and 7.2% to 31.1%, respectively (each p Ͻ0.001). Female gender, black race, Hispanic ethnicity, lower income, older age and treatment at community hospitals were associated with lower use of nephron sparing. Conclusions: While total nephrectomy is still likely overused for small renal cell carcinoma, nephron sparing surgery for stage I renal cell carcinoma has increased substantially in the last 15 years with about 4-fold increases across tumor sizes. These trends appear to be ongoing but sociodemographic disparities exist which must be rectified.

Contemporary management of renal cell carcinoma (RCC) in Victoria: implications for longer term outcomes and costs

“…However, patterns of utilisation of PN for pT1a tumours similar to those reported here have been seen in USA population-based data, although some of these studies have used less contemporary population samples [24,25]. Whilst more recent USA data from the Surveillance Epidemiology and End Results Program (SEER) and the National Cancer Database have shown increasing use of nephron-preserving surgery with PN and ablative techniques, significant underutilisation still exists according to the investigators [31,32]. Interestingly, SEER data from 2006 showed PN to represent 45% of kidney surgery for renal tumours of Յ4cm, a figure slightly higher than seen in the present population [32].…”

Partial and radical nephrectomy provide comparable long‐term cancer control for T1b renal cell carcinoma

“…20 Finally, many patients simply do not have access to PN, for reasons that could pertain to traveling time, inability to be treated at a hospital that offers PN, insurance, racial disparity or socioeconomic status. [21][22][23][24][25] Indeed, in analyses focusing on characteristics most associated with PN treatment, the present results showed that younger individuals and males were more likely to be treated with PN than their older and female counterparts. Interestingly, the present results also showed that persons of black race were more likely to be treated with the nephron-sparing approach relative to whites, contrary to results of previous reports that suggested a treatment disparity for blacks.…”

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

“…1 Concomitantly, partial nephrectomy has been increasingly recommended over radical nephrectomy for T1 renal cancers. 2 Advantages of nephron-sparing procedures included improved renal functional outcomes without compromising the oncologic safety.…”