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


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.
Department of Urology, Columbia University Medical Center, New York, NY, USA. Electronic address: max.kates@mssm.edu.
Max
M
Kates
Michael J
MJ
Whalen
Gina M
GM
Badalato
James M
JM
McKiernan
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000208:ethnology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000208:ethnology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data; D012737:Sex Factors; D047368:Tumor Burden; D014481:United States; D044465:White People / Q000706:statistics & numerical data*