Vincent Trudeau1, Alessandro Larcher2, Maxine Sun3, Katharina Boehm4, Paolo Dell'Oglio2, Malek Meskawi5, José Sosa3, Zhe Tian6, Nicola Fossati7, Alberto Briganti8, Pierre I Karakiewicz5. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada. Electronic address: vincent.trudeau.1@umontreal.ca. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada. 6. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. 7. Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY. 8. Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract
BACKGROUND: Local tumor ablation (LTA) and expectant management (EM) represent competing treatment modalities for patients with small renal masses (SRMs) who are unfit for surgery. We examined the potential social discrepancies in the access of LTA and EM. MATERIALS AND METHODS: A total of 1860 patients with cT1a kidney cancer who had undergone either LTA (n = 553) or EM (n = 1307) from 2000 to 2009 were selected from the Surveillance, Epidemiology, and End Results-Medicare database. The baseline patient data (age, comorbidity status, defined as Charlson comorbidity index [CCI], and several sociodemographic variables) and tumor characteristics were examined. A multivariable analysis predicting access to LTA compared with EM was fitted. The subgroup analyses focused on patients aged ≥ 75 years with a CCI of ≥ 2. RESULTS: Compared with LTA patients, the EM patients were significantly older (median age, 78 vs. 77 years; P < .001), more frequently unmarried (43% vs. 37%; P = .02), more frequently of African-American ethnicity (14% vs. 8%; P = .005), and more frequently of low socioeconomic status (SES; 55% vs. 46%; P = .001). No differences were seen according to gender, population density, CCI, or tumor size. In a multivariable analysis predicting access to LTA over EM, older age, African-American ethnicity, male gender, low SES, and unmarried status were associated with lower access to LTA (P ≤ .04 for all). In the subgroup of older and sicker patients, none of the previous sociodemographic characteristics represented barriers to LTA access (P ≥ .1 for all). CONCLUSION: Sociodemographic characteristics might represent barriers to LTA access for patients with SRMs managed nonoperatively. However, these associations vanished when older and sicker patients were examined.
BACKGROUND: Local tumor ablation (LTA) and expectant management (EM) represent competing treatment modalities for patients with small renal masses (SRMs) who are unfit for surgery. We examined the potential social discrepancies in the access of LTA and EM. MATERIALS AND METHODS: A total of 1860 patients with cT1a kidney cancer who had undergone either LTA (n = 553) or EM (n = 1307) from 2000 to 2009 were selected from the Surveillance, Epidemiology, and End Results-Medicare database. The baseline patient data (age, comorbidity status, defined as Charlson comorbidity index [CCI], and several sociodemographic variables) and tumor characteristics were examined. A multivariable analysis predicting access to LTA compared with EM was fitted. The subgroup analyses focused on patients aged ≥ 75 years with a CCI of ≥ 2. RESULTS: Compared with LTA patients, the EM patients were significantly older (median age, 78 vs. 77 years; P < .001), more frequently unmarried (43% vs. 37%; P = .02), more frequently of African-American ethnicity (14% vs. 8%; P = .005), and more frequently of low socioeconomic status (SES; 55% vs. 46%; P = .001). No differences were seen according to gender, population density, CCI, or tumor size. In a multivariable analysis predicting access to LTA over EM, older age, African-American ethnicity, male gender, low SES, and unmarried status were associated with lower access to LTA (P ≤ .04 for all). In the subgroup of older and sicker patients, none of the previous sociodemographic characteristics represented barriers to LTA access (P ≥ .1 for all). CONCLUSION: Sociodemographic characteristics might represent barriers to LTA access for patients with SRMs managed nonoperatively. However, these associations vanished when older and sicker patients were examined.
Authors: Michele Marchioni; Tristan Martel; Marco Bandini; Raisa S Pompe; Zhe Tian; Anil Kapoor; Luca Cindolo; Riccardo Autorino; Alberto Briganti; Shahrokh F Shariat; Luigi Schips; Pierre I Karakiewicz Journal: World J Urol Date: 2017-08-28 Impact factor: 4.226