Patterns of care in adults with renal cell carcinoma: findings in a population based sample.
PURPOSE
Treatment options in patients with renal cell carcinoma have changed in recent years. However, few studies include detailed information on patient, clinical and health system characteristics in the evaluation of surgical management and the use of systemic therapies in community practice.


MATERIALS AND METHODS
We evaluated surgical management and the use of systemic treatments in a national population based sample of 1,263 patients with renal cell carcinoma newly diagnosed in 2004. Patients were identified from the Surveillance, Epidemiology and End Results Program as part of the Patterns of Care studies. We used descriptive statistics to assess treatment in the entire sample and logistic regression analysis to evaluate the associations between patient demographic, clinical and health system characteristics, and surgery in the subset of 1,032 patients who were potentially eligible for partial or radical nephrectomy and an open or laparoscopic procedure.


RESULTS
Surgical treatment in 64.7% of patients (95% CI 60.0%, 69.1%) was radical nephrectomy and most underwent an open rather than a laparoscopic procedure. Although the proportion of all patients receiving systemic treatments was small, 34.3% (95% CI 23.1, 47.5) of those with stage IV disease received systemic treatment. Few patients participated in clinical trials. On multivariate analysis patients who were female, nonwhite, with larger tumors, without comorbid conditions and treated at hospitals without a residency training program were more likely to undergo radical rather than partial nephrectomy (p <0.05). Patients with larger tumors treated at smaller hospitals were more likely to undergo an open rather than a laparoscopic procedure (p <0.05).


CONCLUSIONS
In 2004 open radical nephrectomy was the most common surgical management for renal cell carcinoma. Few patients received systemic therapy. Patient demographic, clinical and health system characteristics were associated with surgery. Evaluation of the diffusion of surgical management and newer systemic agents, and trial participation in community practice will be important for future research.