Back to 2017 Program
Determinants of Active Surveillance in Patients with Small Renal Masses: A National Cancer Database (NCDB) Study
Kevin A. Nguyen, MS, Jamil S. Syed, MD, Brian Shuch, MD, Michael Leapman, MD.
Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: Active surveillance (AS) has been increasingly recognized as a viable management strategy for patients with small renal masses, that affords the delay or avoidance of definitive treatment. However, little is known about national utilization trends for AS, or the factors that influence initial expectant management.
METHODS: We identified patients with clinical T1a renal masses within the National Cancer Database (NCDB) between 2010 to 2014. Patients were excluded based on the following criteria: metastatic or locally advanced disease, unknown management, or those who were offered but refused treatment outside of surveillance. Patients were dichotomized according to receipt of AS versus definitive treatment. Chi square test and t-test were used to evaluate differences in clinical, demographic, socioeconomic, and treatment-related characteristics differences between the two groups. We examined determinants of AS versus definitive treatment among patients with small renal masses using multivariate logistic regression models.
RESULTS: We identified 69,573 patients that satisfied the inclusion criteria. Of the total cohort, 1,953 (2.8) individuals received initial management with AS, while 67,620 (97.2%) received definitive treatment. Treatment modality received included: partial nephrectomy in 37,257 (55.1%); radical nephrectomy in 19,668 (29.1%), cryo-ablation in 6,636 (9.8%), thermal ablation in 2,096 (3.1%), and other definitive therapy in 1,963 (2.9%) . On multivariate analysis, increasing patient age (OR: 1.10, 95% CI: 1.09-1.10, p<0.0001), smaller tumor size (OR: 0.952, 95% CI: 0.946-0.957, p<0.0001), treatment at an academic center vs. community center (OR: 2.10, 95% CI: 1.86-2.36, p<0.0001), treatment region (OR: 1.55, 95% CI: 1.21-1.98, p=0.0006), African American race (OR: 1.53, 95% CI: 1.35-1.76, p<0.0001), insurance status (OR: 1.15, 95% CI: 1.05-1.42, p=0.031), and higher Charlson-Deyo comorbidity index (2 vs. 1) (OR: 1.64, 95% CI: 1.38-1.96, p<0.0001) were significantly associated with increased use of active surveillance as opposed to definitive treatment.
CONCLUSIONS: We observed a clinical, regional, and facility-level differences in the utilization of active surveillance in patients with T1a renal masses. Further investigation is warranted to better understand the forces underlying initial management decisions for patients with small renal masses.
Back to 2017 Program
|
|
|
|
|
