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Differences in the treatment patterns of small renal masses: A disaggregated analyses by race/ethnicity
Samuel Carbunaru1, Jordan M Rich1, Yassamin Neshatvar1
1Department of Urology, New York University School of Medicine, New York, NY.
Objective:
To characterize differences in the management of small renal masses among disaggregated race/ethnic subgroups.
Material And Methods:
We used the National Cancer Database to identify patients diagnosed with clinically localized kidney cancer and tumor size ≤4cm. We studied 16 predefined racial/ethnic subgroups and compared 1) the use of surveillance for tumors <2cm and 2) the use of radical nephrectomy for tumors ≤4cm. We used multivariable logistic regression to evaluate the independent association of race/ethnicity with management, adjusting for baseline characteristics. We also compared our disaggregated analyses to the 6 National Institute of Health aggregate race categories.
Results:
We identified 286,063 patients that met inclusion criteria. For tumors <2cm, Black Non-Hispanic (aOR 1.43) and Mexican patients (aOR 1.29) were significantly more likely to undergo surveillance compared to White patients. For tumors ≤4cm, Black Non-Hispanic (aOR 1.43), Filipino (aOR 1.28), Japanese (aOR 1.28), Mexican (aOR 1.32), and Native Indian patients (aOR 1.15) were significantly more likely to undergo radical nephrectomy compared to White patients. When comparing our disaggregated analyses to the NIH categories, we found that many disaggregated race/ethnic subgroups had associations with management strategies that were not represented by their aggregated group.
Conclusions:
In this study, we found that the use of surveillance for tumors <2cm and radical nephrectomy for tumors ≤4cm varied significantly among certain race/ethnic subgroups. Our disaggregated approach provides information on differences in treatment patterns in particular subgroups that warrant further study to optimize kidney cancer care for all patients.
Insights
Management of small kidney tumors varies significantly across race/ethnic subgroups. Black Non-Hispanic and Mexican patients were more likely to receive surveillance for smaller tumors and radical nephrectomy for larger tumors compared to White patients.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Small renal masses (SRMs) are increasingly detected.
- Management strategies for SRMs include surveillance and radical nephrectomy.
- Understanding disparities in SRM management is crucial for equitable cancer care.
Purpose of the Study:
- To investigate variations in the management of small renal masses (SRMs) across disaggregated race/ethnic subgroups.
- To compare management patterns between specific race/ethnic groups and aggregate National Institute of Health (NIH) categories.
Main Methods:
- Utilized the National Cancer Database to identify patients with clinically localized kidney cancer and tumor size ≤4cm.
- Analyzed 16 predefined racial/ethnic subgroups, comparing surveillance use for tumors <2cm and radical nephrectomy use for tumors ≤4cm.
- Employed multivariable logistic regression to assess the independent association of race/ethnicity with management, adjusting for baseline characteristics.
Main Results:
- Identified 286,063 patients meeting inclusion criteria.
- Black Non-Hispanic and Mexican patients were more likely to undergo surveillance for tumors <2cm compared to White patients.
- Black Non-Hispanic, Filipino, Japanese, Mexican, and Native Indian patients were more likely to undergo radical nephrectomy for tumors ≤4cm compared to White patients.
- Disaggregated analyses revealed management associations not captured by aggregate NIH race categories.
Conclusions:
- Significant variations exist in the use of surveillance and radical nephrectomy for SRMs among specific race/ethnic subgroups.
- A disaggregated approach is essential for identifying nuanced differences in treatment patterns.
- Further research is warranted to optimize kidney cancer care and address identified disparities across all patient populations.
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