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A comparative population‐based analysis of the rate of partial vs radical nephrectomy for clinically localized renal cell carcinoma
Author(s) -
BaillargeonGagné Sara,
Jeldres Claudio,
Lughezzani Giovanni,
Sun Maxine,
Isbarn Hendrik,
Capitanio Umberto,
Shariat Shahrokh F.,
Crépel Maxime,
Alasker Ahmed,
Widmer Hugues,
Arjane Philippe,
Patard JeanJacques,
Perrotte Paul,
Montorsi Francesco,
Graefen Markus,
Karakiewicz Pierre I.
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08745.x
Subject(s) - medicine , nephrectomy , renal cell carcinoma , logistic regression , epidemiology , cohort , surveillance, epidemiology, and end results , population , stage (stratigraphy) , urology , prospective cohort study , surgery , kidney cancer , oncology , demography , kidney , cancer registry , paleontology , environmental health , biology , sociology
Study Type – Prevalence (prospective cohort with good follow up)Level of Evidence 1a OBJECTIVE To examine contemporary (1989–2004) trends in partial nephrectomy (PN) within the Surveillance, Epidemiology and End Results (SEER) database, as among other considerations, a survival benefit due to avoidance of surgically induced renal insufficiency distinguishes PN from radical nephrectomy (RN). PATIENTS AND METHODS Diagnostic, stage and surgical codes of patients with T1‐2N0M0 renal cell carcinoma treated with either PN or RN were assessed. Proportions, trends and multivariable logistic regression models tested the predictors of the use of PN. RESULTS Of 19 733 assessable patients, 2614 (13.2%) and 17 119 (86.8%), respectively, had PN or RN. The use of PN decreased with increasing tumour size, was more frequent in younger patients and increased with more contemporary years of surgery (all P < 0.001). Intriguingly, there was important geographical variability ( P < 0.001), e.g. in the San Francisco‐Oakland Metropolitan Area the absolute PN rate was 16.4%, vs 7.6% in New Mexico ( P < 0.001). In multivariable analyses, tumour size, age, year of surgery, gender and SEER registries were independent predictors of PN use. CONCLUSION Although as expected the rate of PN use increased over time, unexplained variability remained. For example, gender and SEER registries affected the likelihood of PN. These variables warrant further analyses to reduce unnecessary variability and to maximize PN use and its benefit.