z-logo
open-access-imgOpen Access
Cytoreductive nephrectomy for metastatic renal cell carcinoma: inequities in access exist despite improved survival
Author(s) -
Patel Manish I.,
Beattie Kieran,
Bang Albert,
Gurney Howard,
Smith David P.
Publication year - 2017
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1137
Subject(s) - medicine , renal cell carcinoma , nephrectomy , proportional hazards model , comorbidity , logistic regression , cancer , oncology , urology , kidney
The use of cytoreductive nephrectomy ( CRN ) in the targeted therapy era is still debated. We aimed to determine factors associated with reduced use of CRN and determine the effect of CRN on overall survival in patients with metastatic renal cell carcinoma ( RCC ). All advanced RCC diagnosed between 2001 and 2009 in New South Wales, Australia, were identified from the Central Cancer Registry. Records of treatment and death were electronically linked. Follow‐up was to the end of 2011. Multivariable logistic regression analysis was used to determine factors associated with the receipt of CRN . Cox proportional hazards model was used to determine factors associated with survival. A total of 1062 patients were identified with metastatic RCC of whom 289 (27%) received CRN . There was no difference in the use of CRN over the time period of the study. Females ( OR 0.68 (95% CI : 0.48–0.96)), unmarried individuals ( OR 0.68 (95% CI : 0.48–0.96)), treatment in a nonteaching hospital ( OR 0.26 (95% CI : 0.18–0.36)) and individuals without private insurance ( OR 0.29 (95% CI : 0.20–0.41)) all had reduced likelihood of receiving CRN . On multivariable analysis, not receiving CRN resulted in a 90% increase in death ( HR 1.90 (95% CI : 1.61–2.25)). In addition, increasing age ( P  < 0.001), increasing Charlson comorbidity status ( P  = 0.002) and female gender also had a significant independent association with death. Despite a strong association with improved survival, individuals who are elderly, female, have treatment in a nonteaching facility or have no private insurance have a reduced likelihood of receiving CRN .

The content you want is available to Zendy users.

Already have an account? Click here to sign in.
Having issues? You can contact us here