title: Significant heterogeneity in terms of diagnosis and treatment of renal cell carcinoma at a private and public hospital in Brazil.
abstract: OBJECTIVE
  A great number of small renal lesions have now been detected. Nowadays, partial nephrectomy has more frequently been adopted for surgical treatment of earlier stage disease. Previous studies have associated patient, institutional, and health care system factors with surgery type. The aim of this study was to compare the diagnosis and treatment of renal cell carcinoma (RCC) according to hospital type, public versus private, in our country.
  
  
  METHODS
  We retrospectively evaluated 183 patients with RCC who underwent radical nephrectomy or nephron-sparing surgery between 2003 and 2007 in two hospitals, one private and one public. Patient demographic, clinical, surgery, and pathologic characteristics were analyzed.
  
  
  RESULTS
  The radical nephrectomy rate was higher at the public hospital than at the private hospital (75% vs. 57%, p = 0.008). Overall, patients at the public hospital presented larger tumors than did the patients who were cared for privately. Furthermore, small renal masses were significantly more prevalent in private care (57.8% vs. 28.3%). Patients at the public hospital showed a higher incidence of capsular invasion (p = 0.008), perirenal fat invasion (p < 0.01), lymph node involvement (p < 0.001), and a lower incidence of initial tumors. pT1 tumors were reported in 41% of patients at the public hospital and in 72% at the private hospital (p < 0.001).
  
  
  CONCLUSIONS
  Patients with RCC cared for at our public referral hospital showed a more advanced stage than RCC treated at the private institution.
authors.affiliation: University of São Paulo, Medical School, Urology Division, São Paulo, Brazil. marcosdallogliouro@terra.com.br
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Rafael
authors.initials: R
authors.lastname: Coelho
authors.forename: Roberto
authors.initials: R
authors.lastname: Lopes
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Antunes
authors.forename: Alexandre
authors.initials: A
authors.lastname: Crippa
authors.forename: Cesar
authors.initials: C
authors.lastname: Camara
authors.forename: Katia R M
authors.initials: KR
authors.lastname: Leite
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult