1112 THE IMPACT OF PRE-TREATMENT CHARACTERISTICS ON MANAGEMENT OF THE STAGE I RENAL MASS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121112 THE IMPACT OF PRE-TREATMENT CHARACTERISTICS ON MANAGEMENT OF THE STAGE I RENAL MASS Marc Smaldone, Gauthami Churukanti, Jay Simhan, Jose Reyes, Fang Zhu, Alexander Kutikov, Rosalia Viterbo, David Chen, Richard Greenberg, and Robert Uzzo Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Gauthami ChurukantiGauthami Churukanti Philadelphia, PA More articles by this author , Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Jose ReyesJose Reyes Philadelphia, PA More articles by this author , Fang ZhuFang Zhu Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , and Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1220AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine associations between pre-treatment patient characteristics and selected management strategy in patients presenting with clinical stage I renal masses to a large tertiary care center. METHODS We queried our prospectively maintained kidney cancer database to identify all patients with clinical stage I (≤7cm) renal tumors undergoing active surveillance (AS), tumor ablation (ABL), partial nephrectomy (PN), and radical nephrectomy (RN) from 2005-2011. Patient and tumor characteristics were compared between treatment groups using ANOVA and chi square analyses. The associations between pre-treatment characteristics and treatment strategy were assessed for each treatment group using logistic regression models adjusting for demographic characteristics, clinical severity, anatomic complexity, and year treated. RESULTS 1,034 patients (mean age 62.3±12.8 years) with clinical stage I lesions (mean tumor size 3.3±1.5 cm, mean nephrometry score [NS] 7.5±1.9) met inclusion criteria. Patients were managed with AS (n=266, 25.7%), ABL (n=63, 6.1%), PN (n=401, 38.8%), and RN (n=304, 29.4%) respectively. When stratified by treatment group, significant differences were observed with respect to patient age, gender, CCI score, pre-operative glomerular filtration rate (GFR), chronic kidney disease stage, history of previous abdominal surgery, history of previous malignancy, pre-treatment tumor size, NS sum, presence of a solitary kidney, multiple tumors, and presence of bilateral masses (all p values <0.05). No differences were noted in race, ECOG status, or body mass index. Controlling for pre-treatment characteristics and year treated, tumor size was an independent predictor of AS (OR 0.76 [CI 0.6-0.9]), ABL (OR 0.45 [CI 0.2-0.9]), and RN (OR 1.88 [CI 1.5-2.4]), while CCI was an independent predictor of AS (OR 1.43 [CI 1.2-1.7]) and PN (OR 0.76 [CI 0.6-0.9]). With each increasing year, patients were more likely to undergo PN (OR 1.39 [CI 1.2-1.6]), and less likely to undergo AS (OR 0.78 [CI 0.7-0.9]) or RN (OR 0.81 [CI 0.7-0.99]), which may reflect changing referral and/or practice patterns. CONCLUSIONS Of measured pre-treatment characteristics, tumor size, patient co-morbidity, and year of treatment most consistently predicted treatment type in patients presenting with localized stage I masses. These data may prove useful for future studies investigating provider and institutional variation in practice patterns. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e451 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Smaldone Philadelphia, PA More articles by this author Gauthami Churukanti Philadelphia, PA More articles by this author Jay Simhan Philadelphia, PA More articles by this author Jose Reyes Philadelphia, PA More articles by this author Fang Zhu Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...