ASCO GU 2018: Treatment trends of localized renal cell carcinoma by hospital type: A NCDB analysis

San Francisco, CA ( Accounting for operative, oncologic and comorbid risks guide treatment recommendations for localized kidney cancers. The authors hypothesized that individualized surgical decision making may also be influenced by surgical center and volume.

The National Cancer Database (NCDB) was queried for patients 18-80 years old with pT1a-T2bN0M0 renal cell carcinoma (RCC), treated by partial (PN) or radical nephrectomy (RN), or ablation (ABL) from 2004-2014. After adjusting for clinicopathologic characteristics, the authors evaluated the association of hospital volume and center classification with receipt of PN. High volume was defined as the top 10% in treatment volume.

A total of 142,090 patients met the study’s inclusion criteria, where 58% (n = 82,498) and 41% (n = 58,873) were treated by RN and PN, respectively, and 1% (n = 719) by ABL. The utilization of PN increased over time (in 2004- 24% vs 2014- 53%; p < 0.001). Stratified by tumor stage, 60% (n = 47,484) of pT1a and 24% (n = 9,906) of pT1b tumors were treated by PN. On multivariable analysis, patients treated at a high-volume center (OR 1.89, 95% CI 1.57-2.28) had a greater likelihood of receiving a PN when compared to treatment elsewhere. Additionally, compared to a community cancer program, treatment at a comprehensive community cancer center (OR 1.39, 95%CI 1.23-1.57), academic/research (OR 1.67, 95%CI 1.47-1.90), or integrated network cancer program (OR 1.48, 95%CI 1.24-1.77) had a higher likelihood of receiving a PN. The median distance travelled was 9.8 and 18.1 miles, for treatment at non high volume and high volume centers, respectively. An inverse correlation was noted between increasing tumor stage and receipt of PN, compared to pT1a tumors (pT1b [OR 0.22, 95%CI 0.20-0.23], pT2a [OR 0.06, 95%CI 0.05-0.06], pT2b [OR 0.03, 95%CI 0.02-0.03]).

In the NCDB, despite increased utilization of PN at higher volume centers, the majority of localized renal tumors are still treated with RN. Smaller tumor size, treatment at a higher volume centers, comprehensive community cancer centers, academic/research programs, or integrated network cancer programs increase the likelihood of receipt of PN. Evaluation of population based registries aid in understanding localized RCC surgical management and may help quality improvement efforts.

Presented by: David B. Cahn, Fox Chase Cancer Center, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan, at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA