Victor S Chen1, Robert Abouassaly2, Christopher M Gonzalez3, Alexander Kutikov4, Marc C Smaldone4, Neal J Meropol5, Sarah P Psutka6, Stephen B Williams7, Rebecca O'Malley8, Hillary M Sedlacek3, Simon P Kim9. 1. Case Western Reserve University School of Medicine, Cleveland, OH. 2. Case Western Reserve University School of Medicine, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH; Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH. 3. Case Western Reserve University School of Medicine, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH. 4. Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, PA. 5. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH; Flatiron Health, New York, NY. 6. Division of Urologic Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL. 7. Department of Urology, University of Texas Medical Branch, Galveston, TX. 8. Albany VA Medical Center, Albany, NY. 9. Case Western Reserve University School of Medicine, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH; Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH; Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT. Electronic address: simkim@me.com.
Abstract
OBJECTIVE: To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort. METHODS: Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors. RESULTS: Among 12,515 patients undergoing RPN in our cohort, 8.3% had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9%), we observed a higher proportion of PSM among African American (AA) (10.8%; P = 0.005) and Hispanic/Latino patients (8.8%; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4% vs. 6.9%; odds ratio = 1.57; P<0.001). CONCLUSIONS: In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race.
OBJECTIVE: To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort. METHODS: Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors. RESULTS: Among 12,515 patients undergoing RPN in our cohort, 8.3% had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9%), we observed a higher proportion of PSM among African American (AA) (10.8%; P = 0.005) and Hispanic/Latino patients (8.8%; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4% vs. 6.9%; odds ratio = 1.57; P<0.001). CONCLUSIONS: In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race.
Authors: Joshua Sterling; Zorimar Rivera-Núñez; Hiren V Patel; Nicholas J Farber; Sinae Kim; Kushan D Radadia; Parth K Modi; Sharad Goyal; Rahul Parikh; Robert E Weiss; Isaac Y Kim; Sammy E Elsamra; Thomas L Jang; Eric A Singer Journal: Clin Genitourin Cancer Date: 2020-03-20 Impact factor: 2.872
Authors: Claire M de la Calle; Samuel L Washington; Peter E Lonergan; Maxwell V Meng; Sima P Porten Journal: World J Urol Date: 2020-07-31 Impact factor: 4.226