The effect of race and gender on the surgical management of the small renal mass

Urol Oncol. 2013 Nov;31(8):1794-9. doi: 10.1016/j.urolonc.2012.05.005. Epub 2012 Jun 9.

Abstract

Background: To date, no population studies have been designed to assess the impact of race and gender on the rate of nephron-sparing surgery (NSS) across the United States.

Materials and methods: The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients with T1a renal cell carcinoma (RCC) treated over the most recent decade, 1998-2007. Baseline socio-demographic data were compared between Caucasian and African-American patients using χ(2) and t-test analysis, and rates of radical nephrectomy (RN) were compared for all permutations of race and gender. A multivariate logistic regression model was in turn created with these variables to predict the odds of undergoing a radical nephrectomy. No prior assumptions were made regarding superiority of partial nephrectomy (PN) over RN as a therapeutic intervention.

Results: A total of 14,953 patients were eligible for inclusion in this study, and of these, 1,804 (12%) were African-American. Comparably, African-American patients were younger (<50 years; 23 vs. 28%, P < 0.001), and had an increased rate of high grade disease (13 vs. 16%, P < 0.001). Among different subsets of race and gender, African-American women received PN least often (28%) compared with all other groups, with African-American women at a 47% increased risk of undergoing RN compared with Caucasian male counterparts (95% CI: 1.24-1.73).

Conclusions: Significant racial and gender disparities exist with regard to utilization of nephron-sparing surgery for small renal masses, particularly in African-American women. Further efforts should be directed to elucidating and addressing the rationale behind this disparity to ensure the uniformity of care.

Keywords: Nephrectomy; Renal cell carcinoma; SEER program.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Carcinoma, Renal Cell / ethnology
  • Carcinoma, Renal Cell / surgery*
  • Chi-Square Distribution
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Humans
  • Kidney / pathology
  • Kidney / surgery
  • Kidney Neoplasms / ethnology
  • Kidney Neoplasms / surgery*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nephrectomy / methods
  • Risk Factors
  • SEER Program / statistics & numerical data
  • Sex Factors
  • Tumor Burden
  • United States