PD52-12 RACIAL DIFFERENCES IN UTILIZATION OF CYTOREDUCTIVE SURGERY AMONG METASTATIC RENAL CELL CARCINOMA PATIENTS RECEIVING SYSTEMIC THERAPY

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (PD52)1 Sep 2021PD52-12 RACIAL DIFFERENCES IN UTILIZATION OF CYTOREDUCTIVE SURGERY AMONG METASTATIC RENAL CELL CARCINOMA PATIENTS RECEIVING SYSTEMIC THERAPY Adan Becerra, Neil Buac, Matthew Greydanus, Morgan Sturgis, David Cao, Carol Feng, Christopher Coogan, Edward Cherullo, Srinivas Vourganti, Andrew Stephenson, and Alexander Chow Adan BecerraAdan Becerra More articles by this author , Neil BuacNeil Buac More articles by this author , Matthew GreydanusMatthew Greydanus More articles by this author , Morgan SturgisMorgan Sturgis More articles by this author , David CaoDavid Cao More articles by this author , Carol FengCarol Feng More articles by this author , Christopher CooganChristopher Coogan More articles by this author , Edward CherulloEdward Cherullo More articles by this author , Srinivas VourgantiSrinivas Vourganti More articles by this author , Andrew StephensonAndrew Stephenson More articles by this author , and Alexander ChowAlexander Chow More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002079.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Systemic targeted therapy (STT) is considered the first-line treatment for the management of metastatic renal cell carcinoma (mRCC), which presents in 3 out of 10 patients diagnosed with RCC. However, national guidelines also support the role of initial cytoreductive surgery (CS) in combination with STT in suitable patients with favorable risks given the potential benefit in overall survival in this select population. There is a paucity of literature examining contemporary utilization of CS with STT and whether it varies among racial subgroups. The objective of this study was to evaluate whether racial differences exist in the use of CS among mRCC patients receiving STT. METHODS: Clinical stage IV RCC patients who received STT were identified in the National Cancer Database (2006-2017). Patients were categorized as undergoing CS+STT vs. STT. Racial subgroups that were evaluated were White, Black, Hispanic, and Other. A multivariable logistic regression was used to assess the association between race/ethnicity and utilization of CS+STT while controlling for patient, tumor, and hospital factors. RESULTS: We identified 21,763 mRCC patients who met inclusion criteria, of which 29% underwent CS. Black, Hispanic, and Other patients comprised 9%, 7%, and 3% of the cohort, respectively. The unadjusted rates of CS utilization among White, Black, Hispanic, and Other patients were 29%, 22%, 29%, and 30%, respectively and remained stable over time. In adjusted models, independent of patient, tumor, and hospital factors, the only racial differences were that Black patients had 29% lower odds of undergoing CS compared to White patients (OR=0.71, 95% CI=0.61-0.81). Other factors associated with lower CS utilization were older age, Medicaid/no insurance (compared to private), nonacademic hospitals, and urban/rural residence (compared to metro). Black patients experienced worse 5-year overall survival (HR=1.11, p=0.01). CONCLUSIONS: The use of CS for mRCC in the STT era has remained stable over time for all patients, yet Black patients are still less likely to undergo CS. These effects were not explained by differences in income, education, insurance, or other sociodemographic factors. Given that the survival benefit of CS may only be seen in select populations, it is unclear whether lower utilization of CS among Black patients reflects specific patient selection criteria or is a product of other patient factors that are difficult to capture in analysis, such as differences in access to health care, certain comorbid conditions, or varying patient attitudes towards surgical intervention. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e915-e915 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adan Becerra More articles by this author Neil Buac More articles by this author Matthew Greydanus More articles by this author Morgan Sturgis More articles by this author David Cao More articles by this author Carol Feng More articles by this author Christopher Coogan More articles by this author Edward Cherullo More articles by this author Srinivas Vourganti More articles by this author Andrew Stephenson More articles by this author Alexander Chow More articles by this author Expand All Advertisement Loading ...