Faculty Collaboration Database

Evolving Trends for Selected Treatments of T1a Renal Cell Carcinoma. Urology 2019 Oct;132:136-142

Date

07/08/2019

Pubmed ID

31279691

DOI

10.1016/j.urology.2019.06.029

Scopus ID

2-s2.0-85072718431 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

OBJECTIVE: To evaluate contemporary trends in the management of small renal masses and how patient age has impacted practice patterns.

METHODS: Using the NCDB Participant User File (PUF) from 2002 to 2015, we identified patients with T1a renal masses. The initial treatment was categorized as radical nephrectomy (RN), partial nephrectomy (PN), ablation, or active surveillance (AS). A multinominal logistic regression model was used to identify significant factors impacting treatment.

RESULTS: We identified 75,691 patients for analysis. RN, PN, and ablation accounted for 28%, 52%, and 12%, respectively, while 8% were managed with AS. In the past decade the likelihood of undergoing PN, ablation, or surveillance compared to RN has consistently increased, independent of age, sex, race, comorbidity, tumor size, or institution. As age increased, patients were independently less likely to undergo PN and more likely to be managed with ablation or AS. Compared to patients under 40 years of age, patients between 70 and 79 were far less likely to undergo PN (RR 0.58, P< .01), and far more likely to undergo either ablation (RR 5.53, P< .01) or AS (RR 3.7, P< .01).

CONCLUSION: Trends in small renal mass management continue to evolve, with PN supplanting RN over the past decade as the predominant surgical treatment. Age significantly impacts treatment selection, particularly in older cohorts whom are much more likely to undergo ablation or AS. While the use of minimally invasive therapies has increased over the past decade, AS lags behind despite quality data supporting its use. When controlling for multiple clinical factors, PN, ablation and surveillance have consistently increased in utilization compared to RN.

Author List

Doolittle J, Piotrowski J, Zuk K, Jacobsohn K, Langenstroer P, See W, Johnson S

Authors

Scott C. Johnson MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin
Peter Langenstroer MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Carcinoma, Renal Cell
Female
Humans
Kidney Neoplasms
Male
Middle Aged
Neoplasm Staging
Nephrectomy
Tumor Burden
Watchful Waiting