PD07-04 TREATMENT TRENDS OF LOCALIZED RENAL CELL CARCINOMA BY HOSPITAL TYPE: AN ANALYSIS OF THE NATIONAL CANCER DATABASE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2018PD07-04 TREATMENT TRENDS OF LOCALIZED RENAL CELL CARCINOMA BY HOSPITAL TYPE: AN ANALYSIS OF THE NATIONAL CANCER DATABASE David Cahn, Elizabeth Handorf, Daniel Edwards, Laura Kidd, Daniel Geynisman, Brian Kadow, Richard Greenberg, Rosalia Viterbo, David Chen, Alexander Kutikov, Robert Uzzo, and Marc Smaldone David CahnDavid Cahn More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Daniel EdwardsDaniel Edwards More articles by this author , Laura KiddLaura Kidd More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , Brian KadowBrian Kadow More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , David ChenDavid Chen More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.437AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Weighing operative, oncologic and co-morbid risks guide treatment recommendations for localized kidney cancers. AUA guidelines recommend partial nephrectomy as a preferred therapy for small renal masses. We hypothesize that individualized surgical decision making may also be influenced by surgical center and volume. METHODS The National Cancer Database (NCDB) was queried for patients 18-80 years old with pT1a-T2bN0M0 RCC, treated by partial (PN) or radical nephrectomy (RN), or ablation (ABL) from 2004-2014. After adjusting for clinicopathologic characteristics, we evaluated the association of hospital volume (vol) and center classification with receipt of PN. High vol was defined as the top 10% in treatment volume. RESULTS 142,090 patients met inclusion criteria, where 58% (n=82,498) and 41% (n=58,873) were treated by RN and PN, respectively, and 1% (n=719) by ABL. The utilization of PN increased over time (2004: 24% vs 2014: 53%; p<0.001). Stratified by tumor stage, 60% (n=47,484) of pT1a and 24% (n=9,906) of pT1b tumors were treated by PN. On multivariate analysis, patients treated at a high-vol center (OR 1.89, 95% CI 1.57-2.28) had a greater likelihood of receiving a PN when compared to treatment elsewhere. Additionally, compared to a community cancer program, treatment at a comprehensive community cancer center (OR 1.39, 95%CI 1.23-1.57), academic/research (OR 1.67, 95%CI 1.47-1.90), or integrated network cancer program (OR 1.48, 95%CI 1.24-1.77) had a higher likelihood of receiving a PN. The median distance travelled was 9.8 and 18.1 miles, for treatment at non high vol and high vol centers, respectively. An inverse correlation was noted between increasing tumor stage and receipt of PN, compared to pT1a tumors (pT1b [OR 0.22, 95%CI 0.20-0.23], pT2a [OR 0.06, 95%CI 0.05-0.06], pT2b [OR 0.03, 95%CI 0.02-0.03]). CONCLUSIONS In the NCDB, despite increased utilization of PN recently, the majority of localized renal tumors are still treated with RN. Smaller tumor size, treatment at a higher vol centers, comprehensive community cancer centers, academic/research programs, or integrated network cancer programs increase the likelihood of receipt of PN. Evaluation of population based trends aid in understanding localized RCC surgical management and may help quality improvement efforts to increase adoption of PN at non-high vol and non-specialized community centers. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e157-e158 Advertisement Copyright & Permissions© 2018MetricsAuthor Information David Cahn More articles by this author Elizabeth Handorf More articles by this author Daniel Edwards More articles by this author Laura Kidd More articles by this author Daniel Geynisman More articles by this author Brian Kadow More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author David Chen More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...