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Kiechle JE , Abouassaly R , Smaldone MC , Shah ND , Dong S , Cherullo EE , Nakamoto D , Zhu H , Cooney MM , Kim SP
National Trends of Local Ablative Therapy among Young Patients with Small Renal Masses in the United States
Urology. 2015 Nov;86(5) :962-7
PMID: 26341571 URL: https://www.ncbi.nlm.nih.gov/pubmed/26341571
AbstractOBJECTIVE: To assess national trends in the usage of local ablative therapy for small renal masses (SRMs) in a cohort of young patients. Ablation of SRMs has been shown to offer cancer control with limited follow-up. Although ablation is considered effective for patients with limited life expectancy, its use among younger patients may be considered controversial. METHODS: We used the National Cancer Data Base (NCDB) to identify patients between the ages of 40 to 65 years old diagnosed with small renal masses (SRM's) from 2004-2011. Primary outcome was the use of local ablative therapy. Multivariable logistic regression analysis was used to identify patient and hospital factors associated with ablation therapies in this cohort. RESULTS: During the study period, we identified 49,441 patients with SRMs of which 2,789 (5.6%) were treated with ablative therapies. The proportion of patients undergoing ablation gradually rose from 2.2% in 2004 to 6.2% in 2011 (p<0.001). On multivariable analysis, patients were more likely to receive local ablation at academic hospitals (OR: 1.5; p<0.001) compared to community hospitals or primarily insured by Medicaid (OR: 1.4; p<0.001) or Medicare (OR: 1.3; p<0.001) compared to private insurance. CONCLUSIONS: Use of local ablative therapies is gradually rising, but used in a small fraction of young patients with SRMs. Patients treated at high volume, academic hospitals or insured with Medicaid or Medicare were treated to a greater degree with ablation. These results have important implications about understanding the dissemination of ablation and need for long-term cancer surveillance.
NotesKiechle, Jonathan E Abouassaly, Robert Smaldone, Marc C Shah, Nilay D Dong, Shan Cherullo, Edward E Nakamoto, Dean Zhu, Hui Cooney, Matthew M Kim, Simon P Urology. 2015 Nov;86(5):962-7. doi: 10.1016/j.urology.2015.08.016. Epub 2015 Sep 1.