Sociodemographic factors associated with nephrectomy in patients with metastatic renal cell carcinoma.
OBJECTIVE
Studies suggest that radical nephrectomy imparts a survival benefit in select patients with metastatic renal cell carcinoma. We determined the roles of patient age, gender, race and in particular marital status in the decision to pursue nephrectomy and the ensuing effect on overall survival.


METHODS
Using the Surveillance, Epidemiology and End Results database we identified 11,182 patients between 1988 and 2004 who were diagnosed with metastatic renal cell carcinoma. Patients were separated into 2 groups, including those who underwent nephrectomy and those who did not, and they were stratified by the mentioned variables. Logistic regression and Kaplan-Meier analyses were used to determine the likelihood of undergoing nephrectomy and of overall survival in the cohorts.


RESULTS
In the final cohort 3,443 patients (31%) underwent radical nephrectomy. These patients experienced longer median survival than those who did not undergo surgery (11 vs 4 months, p <0.001). The survival benefit was statistically similar regardless of age group, race, gender and marital status. However, nephrectomy was more commonly performed in younger age groups, and in white and married patients. While age group and race were statistically significant predictors of undergoing nephrectomy (OR 0.64, 95% CI 0.61-0.66 and OR 0.79, 95% CI 0.70-0.89, respectively), marital status was the most important predictor (OR 1.52, 95% CI 1.39-1.66).


CONCLUSIONS
Patients with metastatic renal cell carcinoma who undergo radical nephrectomy experience a survival advantage over those who do not undergo surgery. Married patients are more likely to undergo nephrectomy than their unmarried counterparts. Physicians must be aware of this bias when selecting patients for nephrectomy.
Hellenthal
Nicholas J
NJ
Department of Urology, University of California Davis Medical Center, Sacramento, California, USA.
Chamie
Karim
K
Ramirez
Michelle L
ML
deVere White
Ralph W
RW
D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012959:Socioeconomic Factors; D015996:Survival Rate