Presentation Authors: Clark Higganbotham*, Cameron Britton, Brian Cross, Jonathan Heinlen, Oklahoma City, OK
Introduction: Review utilization of No Surgery of Primary Site (No Treatment), Partial Nephrectomy (PN), Local Tumor Destruction (LTD) and Simple or Radical Nephrectomy (RN) for the treatment of invasive, unilateral, clinically localized Stage T1a Kidney Tumors from the years 2011 to 2015 in order to provide updated insight of utilization trends of surgical treatment in the United States of America.
Methods: Data from the National Cancer Database personal use file (NCDB) was used to evaluate trends for patients that underwent surgery to treat Type T1a Kidney Cancer from 2011 to 2015. A total of 58,394 patients with T1a Kidney Cancer were reported to the NCDB. Statistical analysis was performed to assess associations between demographics and surgery utilization. Patients were excluded if their specific cancer or demographics did not fit the scope of this analysis, for example, bilateral presentation or metastasis of the tumor.
Results: The total number of T1a Kidney Cancer tumors in the NCDB increased an average of 792.75 cases per year from 2011 to 2015 with a total increase of 31.42% (10,091 to 13,262). The proportion of patients that did not receive surgery to treat their cancer increased slightly in percentage over time with a peak in 2013 (11.65%, 12.46%, 14.69%, 13.53%, 13.15%), and the total number of cases also increased over time (1,176, 1,359, 1,715, 1,686, 1,744). LTD increased in total number of cases every year from 2011 to 2015 (1,063, 1,199, 1,248, 1,390, 1,583), with an overall increase in prevalence as well (10.53%, 10.99%, 10.69%, 11.16%, 11.94%). The proportion of PN increased slightly from 2011 to 2012, but then remained fairly stable from 2012 to 2015 (53.62%, 55.13%, 54.67%, 55.78%, 55.32%), with a total increase of surgeries each year (5,411, 6,012, 6,383, 6,950, 7,336). The percentage of RN treatment decreased overall with time (24.19%, 21.41%, 19.96%, 19.53%, 19.60%), but the total number of RN increased slightly over time (2,441, 2,335, 2,330, 2,434, 2,599). The other 5.71% cases that were excluded consisted of treatment options such as 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.
Conclusions: Between 2004 and 2009 the use of PN rose significantly and in 2009 the AUA guideline for small renal masses recommended PN as primary treatment for cT1a renal masses. The proportional use of PN, RN, LTD and No Treatment for stage T1a Renal Cell Carcinoma has not significantly changed from 2011 to 2015.