title: A comparative population-based analysis of the rate of partial vs radical nephrectomy for clinically localized renal cell carcinoma.
abstract: METHODS
  Prevalence (prospective cohort with good follow up).
  
  
  METHODS
  1a.
  
  
  OBJECTIVE
  To examine contemporary (1989-2004) trends in partial nephrectomy (PN) within the Surveillance, Epidemiology and End Results (SEER) database, as among other considerations, a survival benefit due to avoidance of surgically induced renal insufficiency distinguishes PN from radical nephrectomy (RN).
  
  
  METHODS
  Diagnostic, stage and surgical codes of patients with T1-2N0M0 renal cell carcinoma treated with either PN or RN were assessed. Proportions, trends and multivariable logistic regression models tested the predictors of the use of PN.
  
  
  RESULTS
  Of 19 733 assessable patients, 2614 (13.2%) and 17 119 (86.8%), respectively, had PN or RN. The use of PN decreased with increasing tumour size, was more frequent in younger patients and increased with more contemporary years of surgery (all P < 0.001). Intriguingly, there was important geographical variability (P < 0.001), e.g. in the San Francisco-Oakland Metropolitan Area the absolute PN rate was 16.4%, vs 7.6% in New Mexico (P < 0.001). In multivariable analyses, tumour size, age, year of surgery, gender and SEER registries were independent predictors of PN use.
  
  
  CONCLUSIONS
  Although as expected the rate of PN use increased over time, unexplained variability remained. For example, gender and SEER registries affected the likelihood of PN. These variables warrant further analyses to reduce unnecessary variability and to maximize PN use and its benefit.
authors.affiliation: Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Baillargeon-Gagné
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Maxime
authors.initials: M
authors.lastname: Crépel
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alasker
authors.forename: Hugues
authors.initials: H
authors.lastname: Widmer
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000209:etiology; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology