Cytoreductive nephrectomy for metastatic renal cell carcinoma: inequities in access exist despite improved survival

Manish I. Patel, Kieran Beattie, Albert Bang, Howard Gurney, David P. Smith

Research output: Contribution to journalArticleResearchpeer-review

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.

LanguageEnglish
Pages2188–2193
Number of pages6
JournalCancer Medicine
Volume6
Issue number10
DOIs
Publication statusPublished - Oct 2017

Fingerprint

Nephrectomy
Renal Cell Carcinoma
Survival
Insurance
South Australia
New South Wales
Death Certificates
Therapeutics
Proportional Hazards Models
Registries
Comorbidity
Logistic Models
Regression Analysis

Bibliographical note

Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Cytoreductive
  • Inequity
  • Laparoscopic
  • Metastatic
  • Renal cell carcinoma
  • Survival

Cite this

Patel, Manish I. ; Beattie, Kieran ; Bang, Albert ; Gurney, Howard ; Smith, David P. / Cytoreductive nephrectomy for metastatic renal cell carcinoma : inequities in access exist despite improved survival. In: Cancer Medicine. 2017 ; Vol. 6, No. 10. pp. 2188–2193.
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title = "Cytoreductive nephrectomy for metastatic renal cell carcinoma: inequities in access exist despite improved survival",
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.",
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Cytoreductive nephrectomy for metastatic renal cell carcinoma : inequities in access exist despite improved survival. / Patel, Manish I.; Beattie, Kieran; Bang, Albert; Gurney, Howard; Smith, David P.

In: Cancer Medicine, Vol. 6, No. 10, 10.2017, p. 2188–2193.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - Cancer Medicine

AU - Patel, Manish I.

AU - Beattie, Kieran

AU - Bang, Albert

AU - Gurney, Howard

AU - Smith, David P.

N1 - Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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