Simon P Kim1, Cary P Gross2, Neal Meropol3, Alexander Kutikov4, Marc C Smaldone4, Nilay D Shah5, James B Yu6, Sarah Psutka7, Jonathon Kiechle8, Robert Abouassaly8. 1. Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Cleveland Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH; Cancer Outcomes Public Policy and Effectiveness Research (COPPER), Yale University, New Haven, CT. Electronic address: simkim@me.com. 2. Cancer Outcomes Public Policy and Effectiveness Research (COPPER), Yale University, New Haven, CT; Department of Medicine, Yale University, New Haven, CT. 3. Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH. 4. Division of Urologic Oncology, Philadelphia, PA. 5. Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN. 6. Department of Radiation Oncology, Yale University, New Haven, CT. 7. Division of Urologic Surgery, Cook County Health and Hospitals Systems, Chicago, IL. 8. Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Cleveland Medical Center, Cleveland, OH.
Abstract
OBJECTIVE: To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy. MATERIALS AND METHODS: Using the National Cancer Database, we identified older patients (≥70y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment-partial nephrectomy (PN), radical nephrectomy, EM, and ablation. Multivariable logistic regression analysis stratified by tumor size (<2, 2-3.9, or 4-7cm) and age groups (70-79 and ≥80y) was used to identify covariates associated with different treatments. RESULTS: Among 41,518 older patients with T1 renal cell carcinoma renal tumors, most were treated with radical nephrectomy (59.0%) followed by PN (20.0%) and ablation (8.4%). Only 12.6% were managed by EM. Among older patients aged 70 to 79 years with renal tumors 2 to 3.9cm, PN was used more frequently in 2008 to 2009 (odds ratio [OR] = 1.32; P = 0.001) and 2010 to 2011 (OR = 1.87; P<0.001) compared to 2002 to 2003 and at academic hospitals (OR = 1.91; P<0.001) compared to community hospitals. Similar trends were observed for patients aged 70 to 79 years with 4 to 7cm tumors and for patients aged≥80 years across renal tumor sizes. CONCLUSIONS: Among older patients with localized renal tumors and limited life expectancy, most are treated surgically with a growing use of PN. A smaller proportion of older patients are managed by EM in the United States.
OBJECTIVE: To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy. MATERIALS AND METHODS: Using the National Cancer Database, we identified older patients (≥70y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment-partial nephrectomy (PN), radical nephrectomy, EM, and ablation. Multivariable logistic regression analysis stratified by tumor size (<2, 2-3.9, or 4-7cm) and age groups (70-79 and ≥80y) was used to identify covariates associated with different treatments. RESULTS: Among 41,518 older patients with T1 renal cell carcinoma renal tumors, most were treated with radical nephrectomy (59.0%) followed by PN (20.0%) and ablation (8.4%). Only 12.6% were managed by EM. Among older patients aged 70 to 79 years with renal tumors 2 to 3.9cm, PN was used more frequently in 2008 to 2009 (odds ratio [OR] = 1.32; P = 0.001) and 2010 to 2011 (OR = 1.87; P<0.001) compared to 2002 to 2003 and at academic hospitals (OR = 1.91; P<0.001) compared to community hospitals. Similar trends were observed for patients aged 70 to 79 years with 4 to 7cm tumors and for patients aged≥80 years across renal tumor sizes. CONCLUSIONS: Among older patients with localized renal tumors and limited life expectancy, most are treated surgically with a growing use of PN. A smaller proportion of older patients are managed by EM in the United States.
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Authors: Alejandro Cruz; Faith Dickerson; Kathryn R Pulling; Kyle Garcia; Francine C Gachupin; Chiu-Hsieh Hsu; Juan Chipollini; Benjamin R Lee; Ken Batai Journal: Int J Environ Res Public Health Date: 2022-02-12 Impact factor: 3.390
Authors: Amit K Patel; Craig G Rogers; Anna Johnson; Sabrina L Noyes; Ji Qi; David Miller; Edward Shervish; Benjamin Stockton; Brian R Lane Journal: Eur Urol Open Sci Date: 2020-12-04