Presentation Authors: Brittany Adamic, Alexander Cope*, Kristine Kuchta, Craig Labbate, Joshua Aizen, Sangtae Park, Chicago, IL
Introduction: Despite earlier recognition of small renal masses, the racial disparities in stage for stage cancer specific survival persists for unclear reasons. Cancer specific survival differs for patients from different socioeconomic and demographic backgrounds, and access to technological advances such as robotic partial nephrectomy (RAS) for small renal masses (SRM) may account for some of these differences. We aimed to investigate disparities in access to advanced surgical techniques and cancer specific survival disparities in patients with SRM.
Methods: All patients who were diagnosed with Renal Cell Carcinoma, Papillary adenocarcinoma, or Chromophobe renal carcinoma as their primary tumor who underwent partial nephrectomy between 2010-2014 were identified from the National Cancer Database. Patients with multiple malignancies or metastases were excluded. Multivariable Cox proportional hazard regression was used for survival analysis.
Results: Of the 13,889 patients identified, most underwent RAS (46%) or open surgery (40%), while only 14% of patients underwent laparoscopic partial nephrectomy. Overall, 74% were white, 16.8% were black, and 5.7% identified as Hispanic. The median follow up was 33 months for all patients. When controlling for tumor size, grade, histology, node status and Charlson comorbidity index on multivariate analysis, overall survival was worse for patients undergoing open surgery compared to RAS (HR 1.23, 95% CI 1.02-1.48, p = 0.027), while there was no difference between laparoscopic and RAS (HR 1.01, 95% CI 0.77-1.33, p=0.918). Hispanic patients had improved overall survival compared to white patients (HR 0.59, 95% CI, p=0.043). Black patients were noted to have increased 30 day mortality rates compared white and Hispanic patients (0.7% vs. 0.3% vs. 0.0%, p=0.037).
Conclusions: Our study suggests that overall survival is greater in patients treated with minimally invasive techniques when controlling for tumor characteristics. Hispanic patients had superior overall survival over white patients, despite less access to minimally invasive surgery. Although tumor biology plays a pivotal role, socioeconomic and demographic background, as well as surgical method are independent predictors in overall survival in renal cell carcinoma patients.