Trends in the surgical management of Stage 1 Renal Cell Carcinoma: findings from a population-based study

OBJECTIVES:

To determine whether use of nephron sparing surgery (NSS) for treatment of stage 1 renal cell carcinomas changed between 2009 and end 2013 in Australia.

PATIENTS AND METHODS:

All adult cases of renal cell carcinoma diagnosed in 2009, 2012, and 2013 were identified through the population-based Victorian Cancer Registry. For each identified patient, trained data-abstractors attended treating hospitals or clinician rooms to extract tumour and treatment data through medical record review. Multivariable logistic regression analyses examined significance of change in use of NSS over time, after adjusting for potential confounders.

RESULTS:

A total of 1836 patients with renal cell carcinoma were identified. Of these, the proportion of cases with stage 1 tumours was 64% in 2009, 66% in 2012, and 69% in 2013. For T1a tumours, the proportion of patients residing in metropolitan areas receiving NSS increased from 43% in 2009 to 58% in 2012 (P<.05), and 69% in 2013 (P<.05). For patients residing in non-metropolitan areas, the proportion receiving NSS increased from 27% in 2009 to 49% in 2012, and 61% in 2013 (P<.01). Univariable logistic regression showed patients with moderate (OR=0.57, 95%CI 0.35-0.94) or severe comorbidities (OR=0.58, 95%CI 0.33-0.99), residing in non-metropolitan areas (OR=0.65, 95%CI 0.47-0.90), were less likely to be treated by NSS, while those attending high volume hospitals (30+ cases/year: OR=1.79, 95%CI 1.21-2.65) and those with higher socio-economic status (OR=1.45, 95%CI 1.02-2.07) were more likely to be treated by NSS. In multivariable analyses, patients with T1a tumours in 2012 (OR=2.00, 95% CI:1.34-2.97) and 2013 (OR=3.15, 95% CI: 2.13-4.68) were more likely to treated by NSS than those in 2009. For T1b tumours, use of NSS increased from 8% in 2009 to 20% in 2013 (P<.05).

CONCLUSION:

This population-based study of the management of T1 renal tumours in Australia found use of NSS increased over the period 2009 to 2013. Between 2009 and 2013 clinical practice for the treatment of small renal tumours in Australia has increasingly conformed to international guidelines.