The National Utilization of Non-Operative Management for Small Renal Masses Over 10 Years.

Abstract

Management of small renal masses (SRMs) often involves a non-operative approach, but there is a paucity of information on its utilization and associated predictors. This study aimed to determine the trends in non-operative management of small renal masses (SRMs) and the predictors of its usage. Utilizing data from the National Cancer Database (NCDB) for localized SRMs (N0/M0, cT1a) diagnosed between 2010-2020, we conducted a cross-sectional study. Non-operative management was defined as expectant management (active surveillance/watchful waiting) or focal ablation. Adjusted odds ratios were calculated using multivariable logistic regression models. Of the 156,734 patients included, 10.5% underwent expectant management and 13.9% underwent focal ablation. Later year of diagnosis was associated with a higher likelihood of non-operative management. In 2020, the odds of receiving expectant management and focal ablation were 90% (1.90 aOR; 95% CI [1.71-2.11]) and 44% (1.44 aOR; 95% CI [1.31-1.57]) higher, respectively, compared to 2010. Black patients had increased odds of expectant management (1.47 aOR; 95% CI [1.39-1.55]) but decreased odds of focal ablation (0.93 aOR; 95% CI [0.88-0.99]). Over the decade, non-operative management for SRMs increased, with expectant management more frequently utilized than focal ablation among Black patients. Possible explanations include race-based differences in physicians' risk assessments and resource allocation. Adjusting for Black race in calculations for Glomerular Filtration Rate (GFR) could influence the differential uptake of these techniques through deflated GFR calculations. These findings highlight the need for research and policies to ensure equitable use of less invasive treatments in small renal masses.