Research and Reports in Urology (Mar 2020)
Temporal Trends in Selecting Patients for Partial Nephrectomy for Small Renal Cell Carcinomas in Alberta, Canada
Abstract
Derek Tilley,1 Taylor Remondini,2 John Van Tuyl,2 Wendy Pak,1 Geoffrey T Gotto3 1Alberta Health Services, Cancer Control, Holy Cross Centre, Calgary, AB, Canada; 2Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; 3Department of Surgery, University of Calgary, Calgary, AB, CanadaCorrespondence: Geoffrey T GottoDepartment of Surgery, University of Calgary, Suite 6625 - 7007 14th Street SW Calgary, Calgary, AB T2V 1P9, CanadaTel +1 403 943-8921Fax +1 403 943-8667Email [email protected]: When technically feasible, partial nephrectomy (pN) is preferred over radical nephrectomy (rN) due to similar oncological control with preservation of renal function. Here, we evaluate the incorporation of pN into practice for small renal masses and examine the associated outcomes.Methods: We included patients who had undergone either a partial or radical nephrectomy in Alberta, Canada for renal cell carcinomas with pathology tumor stage T1a between 2002 and 2014 (N=1449). Patients were excluded if they had multiple tumors or if they were on dialysis prior to nephrectomy.Results: pN use increased over the duration of the study period. Patients treated after the introduction of guidelines (2007) recommending the use of pN were significantly more likely to receive a pN (OR: 2.709, 95% CI: 1.944– 3.775; p< 0.001) after adjusting for baseline estimated glomerular filtration rate (GFR), age, and sex. Patients who received rN were at significantly increased risk of death (HR: 1.528, 95% CI: 1.029– 2.270; p=0.036) after controlling for baseline GFR, age, and sex. Baseline GFR significantly affected odds of receiving pN (p< 0.050) in the entire cohort, but subgroup analysis of more recently diagnosed patients (2011– 2014) showed that only patients with kidney failure (GFR < 15) were less likely to have received pN.Discussion: The utilization of pN for patients with pT1a renal cell carcinoma has increased significantly over time and has been accelerated by the introduction of guideline recommendations. Patients treated with pN over the study period had superior overall survival.Keywords: nephrectomy, T1a, renal cell carcinoma, guideline, survival, adherence
