Presentation Authors: Allison May*, Anirudh Guduru, Johar Syed, Facundo Davaro, Sameer Siddiqui, Zachary Hamilton, Saint Louis, MO
Introduction: Renal masses can be surgically treated by partial nephrectomy (PN) or radical nephrectomy (RN). RN is associated with increased risk of chronic kidney disease, cardiac morbidity, and mortality. In addition, data has shown the oncologic equivalence of PN as treatment for T1a masses. Thus, in 2009, the AUA guideline statement was released, calling for PN to be considered standard of care for T1a renal masses. Despite the guideline changes, many studies have suggested underutilization of PN. We evaluated national trends using the National Cancer Database (NCDB) in the utilization of PN before and after guideline changes.
Methods: Through the NCDB, we identified 99,035 patients from 2004 to 2015 that underwent surgical resection of T1a ( < 4.1 cm) renal masses. We evaluated the treatment trends over time and proportion of patients treated with PN or RN based on age, sex, race, income, insurance status, treatment facility volume, and Charlson comorbidity.
Results: Treatment with PN increased from 40.2% in 2004 to 71.3% in 2015 (P < 0.001). Older patients were more likely to be treated with RN (HR 1.018, P < 0.001), as were those with Charlson score 2 or 3+ (HR 1.288 and 2.074, P < 0.001). Patients with lower income were more likely to be treated with RN (HR 1.186, P < 0.001) as were uninsured patients (HR 1.108, P=.018) and those treated at low volume centers (HR 1.063, P < 0.001). Females were more likely to undergo RN (HR 1.123, P < 0.001) as were blacks (HR 1.339, P < 0.001). While all of these demographic trends persisted after the release of the AUA guidelines, all HRâ€™s decreased except for those for Charlson score and race. Black patients became even more likely to undergo RN (HR 2004-2009 1.248, HR 2010-2015 1.474, P < 0.001), and in 2015 were over 1.6 times as likely to undergo RN. Patients treated with RN spent more time in the hospital (4.1 days vs. 3.5 days, P < 0.001) and had higher overall mortality (17.4% vs. 7.3%, P < 0.001).
Conclusions: Although use of PN for T1a renal masses has increased over time, nearly 30% of patients with T1a masses still underwent RN in 2015. Socioeconomic disparities continue to exist. While most disparities have decreased over time, there has been a concerning increase in use of RN in black patients.