ABSTRACT
Objective
To determine whether use of renal mass biopsy may be associated with a reduction in
surgery for patients with small, localized renal cell carcinoma (cT1aN0M0), especially
among older patients and patients with greater comorbidity burden.
Methods
A total of 106,258 patients with cT1aN0M0 renal cell carcinoma from 2004 to 2015 were
analyzed in the National Cancer Data Base. Multivariable logistic regression identified
independent associations with nonsurgical management, receipt of biopsy, and pathologic
upstaging. Marginal effects were derived by age and comorbidity. A sensitivity analysis
was conducted in years identifying patients undergoing active surveillance (2010-2015).
Results
There was increased use of biopsy (8.0%-15.3%) and nonsurgical management (11.7%-15.6%)
over time. Biopsy was significantly associated with use of nonsurgical management
(OR 4.80 [95%CI 4.58-5.02], P <.001) as well as active surveillance (OR 1.87 [1.69-2.07], P <.001) in the sensitivity analysis. Individual predicted probability of undergoing
nonsurgical management ranged from 3% to 92% (median 31.4% with use of biopsy) and
increased with age and comorbidity. Pathologic tumor upstaging (≥pT3a) occurred more
frequently for patients receiving biopsy compared to no biopsy (5.8% vs 3.3%, P <.001). After adjustment, biopsy remained a statistically significant predictor of
upstaging (OR 1.31 [95%CI 1.24-1.38], P <.001).
Conclusion
Overall, biopsy demonstrated a strong, independent association with reduced use of
surgery for cT1aN0M0 kidney cancer, especially with increasing age and comorbidity.
The potential association of renal mass biopsy with upstaging warrants caution, but
it is uncertain whether it impacts prognosis relative to true perinephric fat invasion.
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Article info
Publication history
Published online: September 16, 2019
Accepted:
August 29,
2019
Received:
June 11,
2019
Footnotes
Financial Disclosures/Funding Source: None.
The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the deidentified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
