Trends in renal tumor surgery delivery within the United States

Dulabon, Lori M.; Lowrance, William T.; Russo, Paul; Huang, William C.

doi:10.1002/cncr.24965

Cited by 153 publications

(113 citation statements)

References 34 publications

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“…16 Another showed a doubled risk of overall mortality in patients younger than 65 years treated with radical rather than partial nephrectomy even after adjusting for preoperative renal function and other potential confounding variables. 17 Most recently a large, single center series confirmed this finding in patients of all ages. 18 With gradual acceptance of the oncological safety of nephron sparing surgery 19 and more recently of the importance of renal preservation, nephron sparing use has been increasing.…”

Section: Discussionmentioning

confidence: 71%

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Treatment Trends for Stage I Renal Cell Carcinoma

et al. 2011

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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.

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Section: Discussionmentioning

confidence: 71%

“…Trends were assessed based on reported primary treatment codes defining total nephrectomy (NCDB codes 40-50), partial nephrectomy (code 30), focal ablation (codes [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] or no surgery (code 00). Nephron sparing surgery included partial nephrectomy or a focal ablation procedure.…”

Section: Discussionmentioning

confidence: 99%

Treatment Trends for Stage I Renal Cell Carcinoma

et al. 2011

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“…9,15 Noncancer controls (NCC) were selected from a 5% random sample of Medicare beneficiaries aged 66 years and only included individuals without a prior cancer diagnosis at the time of matching. To control for potential nonmeasurable differences between cancer and noncancer patients, a separate cancer control group was included.…”

Section: Control Groupsmentioning

confidence: 99%

Overall survival advantage with partial nephrectomy: A bias of observational data?

Shuch¹,

Hanley

Lai

et al. 2013

Cancer

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the Urologic Diseases in America ProjectBACKGROUND: Partial nephrectomy (PN) and radical nephrectomy (RN) are standard treatments for a small renal mass. Retrospective studies suggest an overall survival (OS) advantage, however a randomized phase 3 trial suggests otherwise. The effects of both surgical modalities on OS were evaluated compared with controls. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset. Individuals treated with PN or RN for localized renal cell carcinoma (RCC) measuring 4 cm were compared with 2 control groups (non-muscle-invasive bladder cancer (BCC) and noncancer controls (NCC). Using a greedy algorithm, RCC groups were matched with controls by demographics and comorbidities. OS for surgical groups and controls were compared. The cause of death was evaluated for cancer groups when differences in OS were noted. RESULTS: Patients undergoing PN and RN were matched with controls. All cancer groups had >95% 10-year cancer-specific survival (CSS). Median OS was similar between RN (9.05 years) and BCC (8.67 years; P 5.067) and NCC (8.77 years; P 5.49). Median OS was improved for PN (10.45 years) compared with BCC (8.75 years; P<.001) and NCC controls (8.76 years; P<.001). A multivariate Cox hazards model demonstrated that PN improved OS compared with NCC (hazard ratio, 1.257; P<.001) and BCC (hazard ratio, 1.364; P<.001). CONCLUSIONS: RN patients had similar OS compared with controls, suggesting that this treatment modality does not compromise survival. Patients undergoing PN had improved OS compared with controls, suggesting possible selection bias. The apparent survival advantage conferred by PN in SEER-Medicare case series is likely the result of selection bias involving unmeasured confounders.

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“…The most recent US population-level data report overall rates of PN use for all kidney tumours rising from 15% to 25% between 2002 and 2008. 82 The rate of PN use across population-level data specifically for T1a tumours has been reported as 42% in 2006 58 . Though rates of PN have steadily increased, they still fall below an ideal rate of utilization, particularly in small renal masses.…”

Section: Overall Ratesmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Trends in renal tumor surgery delivery within the United States

Cited by 153 publications

References 34 publications

Treatment Trends for Stage I Renal Cell Carcinoma

Treatment Trends for Stage I Renal Cell Carcinoma

Overall survival advantage with partial nephrectomy: A bias of observational data?

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

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