Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross-sectional population-based study.

Abstract

To describe the use of partial nephrectomy (PN) for patients with stage T1a renal cell carcinoma (RCC) by age group (<65 and ≥65 years) in two Australian states. All adults diagnosed with RCC in 2012 and 2013 were identified through population-based cancer registries in the Australian states of Queensland and Victoria. For each patient, research assistants extracted patient, tumour and treatment data from medical records. Percentages treated by PN were determined for the two age groups. Multivariable logistic regression analyses examined factors associated with PN. Clinicians treating RCC were sent surveys to assess attitudes towards PN. Data were collected on 956 patients (Victoria: n=548; Queensland: n=404) with stage T1a RCC. Of those having surgery (n=865) PN was more common for those aged <65 (61%) than ≥65 years (44%), with this difference significant after adjusting for patient, tumour (OR=0.50, 95%CI: 0.36, 0.70). There were significant interactions between age and treatment centre volume (p<.05) and residential state (p<.05). PN was less likely for younger patients treated at lower volume hospitals(<24 patients a year) but hospital volume was not associated with PN for older patients. PN was less likely for older patients in Queensland than Victoria. In multivariable analyses, age was not related to laparoscopic surgery. Queensland clinicians were less likely than those from Victoria to agree that PN was the treatment of choice for most T1aN0M0 tumours (p<.001). In Australia, patients aged over 65 years with small renal cancers are less likely to be treated by PN than younger patients. The variation in the surgical procedure used to treat older T1a RCC patients by state and hospital volume indicates better evidence is needed to direct practice in this area. This article is protected by copyright. All rights reserved.