In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 2_suppl ( 2016-01-10), p. 564-564
Abstract:
564 Background: While active surveillance has gained traction as a primary treatment strategy for small renal masses in patients with significant competing risks, population level trends of non-surgical management (NSM) remain poorly characterized. Using a large national cancer registry, our objective was to assess temporal trends in utilization of NSM for stage I renal cell carcinoma (RCC). Methods: The National Cancer Database (NCDB) was queried for all patients with stage I RCC from 2003-2012. Patients were categorized as surgical intervention (partial [PN] or radical nephrectomy [RN] ) or NSM, and patients undergoing ablative techniques were excluded from analyses. Temporal trends were assessed using Cochran-Armitage tests. Adjusting for patient, clinical, and tumor characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of NSM. Results: Of 176,975 patients identified, 89% underwent surgical intervention (PN 35.5%, RN 53.5%) and 11% underwent NSM respectively (Stage Ia: 13.1%, Stage Ib: 6.3%). From 2003-2012, utilization of NSM (6.1 vs. 13.1, p 〈 0.001) and PN (24.4 vs. 47.3%, p 〈 0.001) significantly increased, while performance of RN significantly declined (69.5 vs. 39.6, p 〈 0.001). Following adjustment, increased age (51-60 years: OR 1.70 [CI 1.6-1.8]; 61-70 years: OR 2.61 [CI 2.4-2.8] ; 71+ years: OR 6.37 [CI 5.7-7.1]), African American race (OR 1.11 [CI 1.03-1.2] ), Charlson score 2+ (OR 1.34 [CI 1.2-1.4]), and insurance status (uninsured: OR 1.71 [CI 1.5-2.0] ; Medicaid: OR 1.92 [CI 1.7-2.1]; Medicare: OR 1.39 [CI 1.3-1.5] ) were associated with receipt of NSM, while patients with tumors 〉 4cm (OR 0.42 [CI 0.40-0.45]) were less likely to undergo NSM. Conclusions: In hospitals reporting to the NCDB, utilization of NSM as a primary treatment strategy for stage I RCC has doubled from 2003-2012, most notably for tumors ≤ 4cm (Stage Ia). In absence of validated algorithms differentiating between active surveillance, watchful waiting, and those who lost access to care, racial and insurance disparities should be interpreted cautiously.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2016.34.2_suppl.564
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2016
detail.hit.zdb_id:
2005181-5
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