1481 UTILIZATION OF NEPHRON-SPARING SURGERY AMONG RENAL CELL CARCINOMA PATIENTS WITH DIABETES OR HYPERTENSION

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 20101481 UTILIZATION OF NEPHRON-SPARING SURGERY AMONG RENAL CELL CARCINOMA PATIENTS WITH DIABETES OR HYPERTENSION Christopher Filson, David Miller, Julie Ruterbusch, Joanne Colt, Wong-Ho Chow, and Kendra Schwartz Christopher FilsonChristopher Filson Ann Arbor, MI More articles by this author , David MillerDavid Miller Ann Arbor, MI More articles by this author , Julie RuterbuschJulie Ruterbusch Detroit, MI More articles by this author , Joanne ColtJoanne Colt Bethesda, MD More articles by this author , Wong-Ho ChowWong-Ho Chow Bethesda, MD More articles by this author , and Kendra SchwartzKendra Schwartz Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1197AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron-sparing surgery (NSS) is the preferred treatment for patients with early-stage kidney cancer and concurrent risk factors for chronic kidney disease (CKD). In this context, we used population-based data from National Cancer Institute's U.S. Kidney Cancer Study (KCS) to evaluate whether receipt of NSS is more common among patients with renal cell carcinoma (RCC) and concurrent diabetes mellitus (DM) or hypertension (HTN). METHODS The KCS is a population-based case–control study conducted in the metropolitan areas of Detroit and Chicago from 2002-2007. During the study interval, 1,136 patients with kidney cancer consented to both an epidemiological interview and medical record review. From these sources, we ascertained detailed information regarding patient demographics, medical comorbidities, clinical and pathological characteristics of the kidney cancer, and treatment(s) received. We then used bivariate statistical analyses to evaluate differences in the frequency of NSS among patients with or without DM or HTN, including analyses stratified by tumor size. RESULTS Our analytic cohort comprised 894 cases treated surgically for RCC. Among this group, 183 patients (20.5%) underwent NSS; this proportion increased to 34.3% among cases with tumors ≤ 4 cm (p<0.01). Overall, 17% and 59% of patients in the analytic cohort had DM or HTN, respectively. Compared to patients with neither DM nor HTN, the use of NSS was similar for patients with DM alone (19% vs 16% if DM alone, p=0.65) or HTN alone (19% vs 20% if HTN alone, p=0.71); this finding was consistent among patients with tumors ' 4cm. However, patients with both HTN and DM were significantly more likely to receive NSS, compared to patients who did not have either diagnosis (28% vs 19%, p=0.04, Figure). CONCLUSIONS NSS is performed in up to one-third of patients with early-stage kidney cancer, and more frequently among RCC patients with both DM and HTN. However, the finding that NSS is not applied with relatively greater frequency among patients with small renal tumors and important individual CKD risk factors (DM or HTN alone) suggests an immediately-available opportunity to improve surgical care for patients with RCC. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e571 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Filson Ann Arbor, MI More articles by this author David Miller Ann Arbor, MI More articles by this author Julie Ruterbusch Detroit, MI More articles by this author Joanne Colt Bethesda, MD More articles by this author Wong-Ho Chow Bethesda, MD More articles by this author Kendra Schwartz Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...