ABSTRACT
Objective
To evaluate trends in the utilization of active surveillance (AS) in a nationally
representative cancer database. AS has been increasingly recognized as an effective
strategy for patients with small renal masses but little is known about national usage
patterns.
Methods
We identified patients with clinical T1a renal masses within the National Cancer Database
in 2010 through 2014. Patients were classified according to initial management strategy
received including AS, surgery, ablation, or other treatment. We characterized time
trends in the use of AS vs definitive therapy and examined clinical and socio-demographic
determinants of AS among patients with small renal masses using multivariable logistic
regression models.
Results
We identified 59,189 patients who satisfied the inclusion criteria. Of the total cohort,
1733 (2.9%) individuals received initial management with AS, while 57,456 (97.1%)
received definitive treatment. Surveillance rates remained below 5% in all years.
On multivariate analysis, patient age (OR: 1.08, 95% CI 1.08-1.09), smaller tumor
size of <2 cm vs ≥2 cm (OR: 2.43, 95% CI: 2.20-2.7, P < .0001), management at an academic center vs community center (OR: 2.05, 95% CI:
1.83-2.29), and African American vs Caucasian race (OR: 1.56, 95% CI:1.35-1.80) were
independently associated with use of AS as initial management.
Conclusion
In a representative national cohort of patients with small renal masses, we observed
clinical and facility-level differences in the utilization of active surveillance
in patients with T1a renal masses. Further investigation is warranted to better understand
the forces underlying initial management decisions for patients with small renal masses.
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Article info
Publication history
Published online: July 27, 2018
Accepted:
July 2,
2018
Received in revised form:
June 29,
2018
Received:
May 1,
2018
Footnotes
Financial Disclosure:The authors declare that they have no relevant financial interests.
Presentations:Accepted for presentation: 2017 New England Section of the American Urological Association Meeting; 2018 American Urological Association Annual Meeting.
Identification
Copyright
© 2018 Published by Elsevier Inc.
