Presentation Authors: Clark Higganbotham*, Cameron Britton, Brian Cross, Jonathan Heinlen, Oklahoma City, OK
Introduction: To compare the rates of utilization of No Surgery of Primary Site (NT), Partial Nephrectomy (PN), Local Tumor Destruction (LTD), and Simple or Radical Nephrectomy (RN) for treatment of invasive, unilateral, clinically-localized stage T1a kidney tumors from 2011 to 2015 for patients age 30 and older, in order to determine treatment trends based on decade of life.
Methods: Data from the National Cancer Database personal use file (NCDB) was used to evaluate trends for patients that underwent surgery to treat T1a kidney cancer. A total of 57,860 patients over the age of 29 with T1a kidney cancer were reported to the NCDB. Statistical analysis was performed to assess the association between patient's age and clinical approach. Patients were excluded if their cancer or demographics did not fit the scope of this analysis, for example, bilateral presentation or metastasis of the tumor. Patients under the age of 30 were excluded due to the small sample size (126 or less per age). Those included in the study were grouped by decade of life, except those over 80, which comprised a single group. Treatment options excluded from the study were local tumor excision, any nephrectomy (simple, subtotal, complete, partial, simple, total, radical) in continuity with the resection of other organs (i.e. colon or bladder), nephrectomy NOS, surgery NOS, and unknown if surgery performed.
Results: NT is less commonly chosen in patients under the age of 80 but was the most common approach for patients 80+. Rates of NT were 4.12%, 4.46%, 7.50%, 10.25%, 18.08% and 47.89%, respectively among the age groups. Those in the 80+ age group were significantly more likely to undergo no treatment (P < 0.001). LTD had significant differences in utilization rate: 3.54%, 4.97%, 7.54%, 11.80%, 16.63% and 19.39%, respectively (P < 0.001). PN was significantly less likely to be utilized in patients 80 years or older but was the most common surgical approach for all groups under 80: 73.55%, 69.50%, 63.36%, 56.39%, 44.16%, and 17.46%, respectively (P < 0.001). Rates of RN were not significantly different between age groups during this time: 18.79%, 21.07%, 21.60%, 21.56%, 21.13%, 15.26%, respectively.
Conclusions: When controlling for age, patients 80 years or older are more likely to receive no treatment (active surveillance) for T1a kidney tumors, and they are less likely to undergo PN compared to all other age groups. They are no less likely to undergo RN as a treatment option for T1a tumors than any other age group. These results should prompt further evaluation of treatment trends based on age, ensuring the best patient outcomes.