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Title: Cytoreductive nephrectomy for individuals with metastatic renal cell carcinoma: Inequities in access despite improved survival
Authors: Patel MI; Beattie K; Bang A; Gurney H; Smith DP
Categories: Treatment - Systemic Therapies – Clinical Applications
Cancer Type - Kidney Cancer
Keywords: Cytoreductive; Renal cell carcinoma; inequity; laparoscopic; metastatic; survival
Year: 2017
Journal Title: Cancer Medicine
Volume: 6
Issue: 10
Page number start: 2188
Page number end: 2193
Abstract: The use of cytoreductive nephrectomy (CRN) in the targeted therapy era is still debated. We aimed to determine factors associated with reduced use of CRN and determine the effect of CRN on overall survival in patients with metastatic renal cell carcinoma (RCC). All advanced RCC diagnosed between 2001 and 2009 in New South Wales, Australia, were identified from the Central Cancer Registry. Records of treatment and death were electronically linked. Follow-up was to the end of 2011. Multivariable logistic regression analysis was used to determine factors associated with the receipt of CRN. Cox proportional hazards model was used to determine factors associated with survival. A total of 1062 patients were identified with metastatic RCC of whom 289 (27%) received CRN. There was no difference in the use of CRN over the time period of the study. Females (OR 0.68 (95% CI: 0.48-0.96)), unmarried individuals (OR 0.68 (95% CI: 0.48-0.96)), treatment in a nonteaching hospital (OR 0.26 (95% CI: 0.18-0.36)) and individuals without private insurance (OR 0.29 (95% CI: 0.20-0.41)) all had reduced likelihood of receiving CRN. On multivariable analysis, not receiving CRN resulted in a 90% increase in death (HR 1.90 (95% CI: 1.61-2.25)). In addition, increasing age (P < 0.001), increasing Charlson comorbidity status (P = 0.002) and female gender also had a significant independent association with death. Despite a strong association with improved survival, individuals who are elderly, female, have treatment in a nonteaching facility or have no private insurance have a reduced likelihood of receiving CRN.
Division: Cancer Research Division
Funding Body: * NSW Cancer Institute. Grant Number: 10/ECF/2‐29 * National Health and Medical Research Council. Grant Number: 1016598
DOI: 10.1002/cam4.1137
Appears in Collections:Research Articles

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