Affiliation:
1. Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
2. Case Western Reserve University/University Hospitals Urology Institute, Cleveland, OH
3. University Hospitals Case Medical Center, Cleveland, OH
Abstract
472 Background: Since the publication of randomized studies demonstrating a survival advantage in patients with metastatic renal cell carcinoma (mRCC) treated with immunotherapy, cytoreductive nephrectomy (CN) has played an integral role in the management of these patients. Our objective is to describe the use of CN in the eras of immuno and targeted therapy for mRCC. Methods: Using the National Cancer Data Base (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, we identified patients with histologically confirmed mRCC. We examined patient, provider and disease factors associated with CN. We also assessed short-term surgical outcomes of CN. A multivariable logistic regression was used to evaluate factors associated with CN. Results: From 1998 to 2011, 30.1%(17,714) of the 58,810 patients with mRCC underwent CN (Table). Over this timeframe, there was a gradual increase in the proportion undergoing surgery (17.3% to 35.7%). In those who underwent CN, the mean length-of-stay (LOS) was 6.1 days. The 30-day readmission rate and 30-day mortality were 5.6% and 3.8%, respectively. On multivariate analysis, patients who were treated at an academic facility (OR 1.94, 95% CI 1.79-2.11, p <.0001) were more likely to be treated with CN. After adjusting for covariates, patients of African American race (OR 0.52, 95% CI 0.48-0.56, p <.0001), a tumor size of >14cm (OR 0.57, 95%CI 0.52-0.62, p<.0001), or a Charlson/Deyo score of ≥ 2 (OR 0.62, 95% CI 0.57-0.68, p < .0001) were less likely to be treated surgically. Conclusions: Cytoreductive nephrectomy for mRCC appears to be steadily increasing over time, particularly in academic medical centers, even after adjusting for potential confounders. Despite this population’s advanced disease, LOS, 30-day readmission rate and 30-day mortality are relatively low. Our results suggest that CN utilization remains high in the era of targeted therapy. [Table: see text]
Publisher
American Society of Clinical Oncology (ASCO)
Cited by
6 articles.
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