Login to Access Video or Poster Abstract: MP67-15
Sources of Funding: none

Introduction

While the use of partial nephrectomy (PN) has increased over the last decade, it is unclear if the shift has been uniform across the different types of cancer treatment facilities. This study seeks to compare the use of RN across types of Commission on Cancer (CoC)-accredited cancer programs in the United States from 2004-2013.

Methods

Cases of RCC were identified from the Commission on Cancer’s (CoC) National Cancer Data Base (NCDB) Participant User File (PUF) from 2004-2013. Patients with clinical stage I RCC who received either RN or PN as the primary surgical treatment at a CoC-accredited facility were included. Facility types were grouped by case volume (HV= high volume; LV=low volume) and multivariable logistic regression was used to estimate odds ratios for RN overall and stratified by tumor size across types of CoC-accredited cancer programs. Kaplan-Meier curves, Cox regression, and log-rank tests were used to characterize patient survival.

Results

The study population consisted of 114,057 cases (PN=52,654; RN=61,403). Academic/Research Cancer programs (ACAD) performed the most PNs (52.0%), while Comprehensive Community Cancer Programs (CCCP) performed the most RNs (50.1%). Multivariable analysis indicated that when compared to ACAD-HV facilities, cases were more likely to be treated with RN if they received care at a Community Cancer Program (CCP) (OR= 3.082, 95%CI: 2.916-3.257), Integrated Network Cancer Program (INCP) (OR= 1.629, 95%CI: 1.542-1.722), CCCP-LV (OR=3.241, 95%CI: 3.084-3.405), CCCP-HV (OR=2.115, 95%CI: 2.047-2.185), or ACAD-LV (0R= 1.771, 95%CI: 1.682-1.865). The survival curves indicate that the overall risk of death was higher for RN compared to PN across all treatment facility types.

Conclusions

Stage I RCC patients receiving surgical treatment at CoC-accredited cancer programs are more likely to have a RN when receiving care at facilities that are not ACAD-HV. Survival analysis indicates that the benefits associated with PN still remain, regardless of the different treatment facility types. These findings indicate variability in how stage I RCC is surgically treated across CoC-accredited treatment facilities within the United States. Research is required to further explore these differences.

Funding

none