TY - JOUR
T1 - Trends and variations in utilization of nephron-sparing procedures for stage I kidney cancer in the United States
AU - Small, Alexander C.
AU - Tsao, Che Kai
AU - Moshier, Erin L.
AU - Gartrell, Benjamin A.
AU - Wisnivesky, Juan P.
AU - Godbold, James
AU - Sonpavde, Guru
AU - Palese, Michael A.
AU - Hall, Simon J.
AU - Oh, William K.
AU - Galsky, Matthew D.
N1 - Funding Information:
Data were obtained from the NCDB Public dataset (http:// cromwell.facs.org/BMarks/BMPub/Ver10/bm_reports.cfm). The NCDB is a national, hospital-based cancer registry sponsored by the American College of Surgeons Commission on Cancer (CoC) and the American Cancer Society. Since 1996, all CoC-accredited programs have been required to report cancers diagnosed or treated at their facilities to the NCDB. The NCDB contains standardized data elements on patient demographics, tumor characteristics, surgery performed, and the first course of treatment. In addition, the NCDB contains information on patient insurance, location of residence, income level, and type of treatment facility. The NCDB Public dataset allows access to aggregate data categorized by multiple variables but not to individual patient level data [21]. Because no protected health information was present in the dataset, institutional review board approval was not required for this study.
PY - 2013/10
Y1 - 2013/10
N2 - Purpose: The incidental detection of early-stage kidney tumors is increasing in the United States. Nephron-sparing approaches (NS) to managing these tumors are equivalent to radical nephrectomy (RN) in oncologic outcomes and have a decreased impact on renal function. Our objective was to evaluate trends in the use of NS over the past decade and the socioeconomic factors associated with its use. Methods: The National Cancer Database was queried to identify patients with stage I kidney cancer between 2000 and 2008. Patients were classified by the type of surgery as NS (local destruction and local excision) or RN. Patients were further categorized by age, race, insurance status, and income. Log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of NS to RN according to demographic and socioeconomic characteristics. Results: From 2000 to 2008, there were 142,194 cases of kidney cancer reported to the NCDB. In these cases, 43,034 (30.3 %) patients had NS, and 86,431 (60.78 %) patients had RN. The prevalence of NS increased 10 % per year (PR = 1.10, p < 0.0001)-from 20.0 % in 2000 to 45.1 % in 2008. Older age, lower income, Black race, Hispanic ethnicity, and lack of health insurance were associated with a decreased prevalence of NS. Conclusions: NS as a treatment for stage I kidney cancer has increased steadily since 2000. Age, racial, and socioeconomic differences may exist in the utilization of NS. Additional analyses, with patient level data, are required to address the independent significance of these variables in an effort to develop strategies to mitigate these potential disparities.
AB - Purpose: The incidental detection of early-stage kidney tumors is increasing in the United States. Nephron-sparing approaches (NS) to managing these tumors are equivalent to radical nephrectomy (RN) in oncologic outcomes and have a decreased impact on renal function. Our objective was to evaluate trends in the use of NS over the past decade and the socioeconomic factors associated with its use. Methods: The National Cancer Database was queried to identify patients with stage I kidney cancer between 2000 and 2008. Patients were classified by the type of surgery as NS (local destruction and local excision) or RN. Patients were further categorized by age, race, insurance status, and income. Log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of NS to RN according to demographic and socioeconomic characteristics. Results: From 2000 to 2008, there were 142,194 cases of kidney cancer reported to the NCDB. In these cases, 43,034 (30.3 %) patients had NS, and 86,431 (60.78 %) patients had RN. The prevalence of NS increased 10 % per year (PR = 1.10, p < 0.0001)-from 20.0 % in 2000 to 45.1 % in 2008. Older age, lower income, Black race, Hispanic ethnicity, and lack of health insurance were associated with a decreased prevalence of NS. Conclusions: NS as a treatment for stage I kidney cancer has increased steadily since 2000. Age, racial, and socioeconomic differences may exist in the utilization of NS. Additional analyses, with patient level data, are required to address the independent significance of these variables in an effort to develop strategies to mitigate these potential disparities.
KW - Kidney cancer
KW - Nephrectomy
KW - Nephron-sparing surgery
KW - Renal surgery
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U2 - 10.1007/s00345-012-0873-6
DO - 10.1007/s00345-012-0873-6
M3 - Article
C2 - 22622394
AN - SCOPUS:84884813030
SN - 0724-4983
VL - 31
SP - 1211
EP - 1217
JO - World Journal of Urology
JF - World Journal of Urology
IS - 5
ER -
