1367 SURGICAL MANAGEMENT OF T1A LESIONS IN THE 21ST CENTURY: A POPULATION-BASED STUDY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized IV1 Apr 20101367 SURGICAL MANAGEMENT OF T1A LESIONS IN THE 21ST CENTURY: A POPULATION-BASED STUDY Giovanni Lughezzani, Claudio Jeldres, Lars Budaus, Rodolphe Thuret, Daniel Liberman, Maxine Sun, Shahrokh F. Shariat, Philippe Arjane, Hugues Widmer, Wassim Kassouf, Jean-Jacques Patard, Francesco Montorsi, Giorgio Guazzoni, Paul Perrotte, and Pierre I. Karakiewicz Giovanni LughezzaniGiovanni Lughezzani Milano, Italy More articles by this author , Claudio JeldresClaudio Jeldres Montreal, Canada More articles by this author , Lars BudausLars Budaus Hamburg, Germany More articles by this author , Rodolphe ThuretRodolphe Thuret Montpellier, France More articles by this author , Daniel LibermanDaniel Liberman Montreal, Canada More articles by this author , Maxine SunMaxine Sun Montreal, Canada More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat Montreal, Canada More articles by this author , Philippe ArjanePhilippe Arjane Montreal, Canada More articles by this author , Hugues WidmerHugues Widmer Montreal, Canada More articles by this author , Wassim KassoufWassim Kassouf Montreal, Canada More articles by this author , Jean-Jacques PatardJean-Jacques Patard Rennes, France More articles by this author , Francesco MontorsiFrancesco Montorsi Milano, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milano, Italy More articles by this author , Paul PerrottePaul Perrotte Montreal, Canada More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.995AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES According to the National Comprehensive Cancer Network guidelines, partial nephrectomy (PN) should be the standard of care in patients with T1a renal cell carcinoma (RCC) and normal contralateral kidney. Conversely, local tumor ablation (LTA) represents a treatment option for patients with multiple comorbidities or for those with limited life expectancy. METHODS Within the Surveillance, Epidemiology and End Results database, 15785 individuals treated with LTA, PN and RN for histologically proven stage T1a RCC were identified within 17 registries between 2001 and 2006. Trends, proportions, and multivariable logistic regression models assessed patient characteristics and predictors of LTD or PN in this patient population. RESULTS Overall 3.8, 35.0 and 61.2% of patients respectively underwent LTA, PN or RN. The rate of LTA use increased from 1.1 to 7.1% within the studied years of interest (chi-square trend, p<0.001). Similarly, the rate of PN increased from 26.6 to 39.3% within the study period (chi-square trend, p<0.001). In multivariable logistic regression models, the independent predictors of LTA were more advanced age (p<0.001), male gender (p=0.01), and more favorable tumor grade (p<0.001). The independent predictors of PN were younger age (p<0.001), male gender (p=0.008), more favorable tumor grade (p<0.001), and higher socioeconomic status (p=0.001). CONCLUSIONS Local tumor ablation represents a treatment option for highly select patient subgroup and is predominantly offered to elderly individuals with low grade tumors. Surprisingly, its increase (6.5-fold) significantly exceeded that of PN (1.5-fold) between 2001 and 2006. Finally, the use of PN should be encouraged as only 39% of individuals benefitted of this nephron-sparing treatment option in the most recent study year. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e528 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Lughezzani Milano, Italy More articles by this author Claudio Jeldres Montreal, Canada More articles by this author Lars Budaus Hamburg, Germany More articles by this author Rodolphe Thuret Montpellier, France More articles by this author Daniel Liberman Montreal, Canada More articles by this author Maxine Sun Montreal, Canada More articles by this author Shahrokh F. Shariat Montreal, Canada More articles by this author Philippe Arjane Montreal, Canada More articles by this author Hugues Widmer Montreal, Canada More articles by this author Wassim Kassouf Montreal, Canada More articles by this author Jean-Jacques Patard Rennes, France More articles by this author Francesco Montorsi Milano, Italy More articles by this author Giorgio Guazzoni Milano, Italy More articles by this author Paul Perrotte Montreal, Canada More articles by this author Pierre I. Karakiewicz Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...