An analysis of trends in the management of renal masses shows growing use of active surveillance, although some data suggest “a proportion of surveillance cases may have been due to lack of access to care instead of truly choosing active surveillance,” says study author Ketan K. Badani, MD.
An analysis of contemporary trends in the management of clinical T1a renal masses shows growing use of active surveillance.
“The increased utilization of surveillance was statistically significant over the study period, but the magnitude of increase was minimal. Confounding interpretation of the findings, however, are data suggesting that a proportion of surveillance cases may have been due to lack of access to care instead of truly choosing active surveillance,” said Ketan K. Badani, MD, Icahn School of Medicine at Mount Sinai, New York, at the AUA annual meeting in San Francisco.
Dr. Badani is senior author of the study, which was performed using data extracted from the American College of Surgeons National Cancer Database (NCDB). It included 38,456 patients diagnosed from 2010 to 2013 with a cT1aN0M0 renal mass managed with either active surveillance, radical nephrectomy, partial nephrectomy.
Over the 4-year study period, active surveillance use increased from 1.9% to 3.1%, partial nephrectomy use increased from 53.7% to 60.1%, and radical nephrectomy use decreased from 28.7% to 21.8% (p<.001 for all temporal trends). The rate of ablation was low and unchanged between 2010 and 2013.
Analyses of demographic, clinical, and socioeconomic characteristics showed that compared to patients who underwent any definitive treatment, patients on active surveillance were significantly more likely to be African-American, managed at an academic center, or have no insurance, Medicaid or Medicare coverage, smaller tumors, and underwent a renal mass biopsy. In addition, chromophobe renal cell carcinoma was more likely to be managed with active surveillance compared with clear cell renal cell carcinoma.
A multivariable multinomial logistic regression analysis identified older age, African-American race, lower income, and higher level of education as independent predictors for active surveillance utilization.
“The incidence of small renal masses has been increasing because of increasing use of more sensitive imaging modalities. Considering that recent studies support active surveillance as an alternative to nephrectomy and ablation for these tumors, particularly in older patients with comorbidities, we were interested in characterizing trends in its utilization,” said Alp Tuna Beksac, MD, of Icahn School of Medicine at Mount Sinai.
Next:Study has strengths, limitations“The associations we found between active surveillance and both tumor type and patient age suggest that its use may be increasing because it is being implemented for appropriate patients. On the other hand, our findings that black race and lower income were predictors of active surveillance raise concerns that lack of access to health care is driving its utilization.”
Dr. Beksac acknowledged that the study has strengths and limitations that are related to its use of the NCDB.
“The NCDB is a huge dataset that captures about 70% of all cancer diagnoses across the United States. In any administrative database, however, there can be mistakes and inconsistencies in the data entries. In addition, active surveillance is not a data point in the NCDB, and so the identification of patients who received active surveillance was done by exclusion, after eliminating patients who underwent nephrectomy or ablation,” he explained.
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