title: Clinical characteristics associated with treatment type for localized renal tumors: implications for practice pattern assessment.
abstract: OBJECTIVE
  To determine the associations between the pretreatment characteristics and treatment selection in patients presenting with clinical stage I renal masses.
  
  
  METHODS
  Using institutional data, patients presenting with clinical stage I (≤ 7 cm) renal tumors that were managed with active surveillance (AS), tumor ablation (ABL), partial nephrectomy (PN), or radical nephrectomy (RN) from 2005 to 2011 were identified. The associations between the pretreatment characteristics and the selected treatment strategy were assessed using multinomial regression models, with RN as the reference group.
  
  
  RESULTS
  A total of 969 patients (mean age 61.9 ± 12.8 years) with 1034 clinical stage I lesions (mean tumor size 3.3 ± 1.5 cm) met the inclusion criteria. The patients were initially treated with RN (29.4%), PN (38.8%), ABL (6.1%), and AS (25.7%). Traditionally captured covariates, including older age (PN, odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.99]) and decreasing tumor size (PN, OR 0.2, 95% CI 0.1-0.4; ABL, OR 0.01, 95% CI 0.0-0.1; AS, OR 0.2, 95% CI 0.1-0.3) were associated with alternative treatment types compared with RN. However, the characteristics associated with treatment type that are not included in traditional registry or administrative data included the presence of a solitary kidney (PN, OR 11.9, 95% CI 2.9-48.9; ABL, OR 15.5, 95% CI 2.5-98.1; AS, OR 7.1, 95% CI 1.3-39.3) and high complexity nephrectomy score (PN, OR 0.1, 95% CI 0.1-0.3; ABL, OR 0.1, 95% CI 0.0-0.6; AS, OR 0.1, 95% CI 0.03-0.3).
  
  
  CONCLUSIONS
  Pretreatment characteristics associated with treatment type in our series, including the presence of a solitary kidney and anatomic complexity, are poorly captured using administrative and registry data. Observational studies investigating the variations in practice patterns for stage I renal masses require improved integration of clinical and tumor characteristics to reduce selection biases.
authors: Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA 19111, USA. marc.smaldone@fccc.edu
authors: Marc C
authors: MC
authors: Smaldone
authors: Gauthami
authors: G
authors: Churukanti
authors: Jay
authors: J
authors: Simhan
authors: Simon P
authors: SP
authors: Kim
authors: Jose
authors: J
authors: Reyes
authors: Fang
authors: F
authors: Zhu
authors: Alexander
authors: A
authors: Kutikov
authors: Rosalia
authors: R
authors: Viterbo
authors: David Y T
authors: DY
authors: Chen
authors: Richard E
authors: RE
authors: Greenberg
authors: Robert G
authors: RG
authors: Uzzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000706:statistics & numerical data; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000706:statistics & numerical data; D016017:Odds Ratio; D059351:Organ Sparing Treatments; D010818:Practice Patterns, Physicians'; D012042:Registries / Q000592:standards; D012189:Retrospective Studies; D057832:Watchful Waiting / Q000706:statistics & numerical data; D055815:Young Adult
references: Urology. 2006 Feb;67(2):254-9
references: 16442601
references: J Urol. 2008 Jun;179(6):2131-5
references: 18423754
references: N Engl J Med. 2004 Sep 23;351(13):1296-305
references: 15385656
references: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references: 12187163
references: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references: 22237781
references: Urology. 2012 May;79(5):1027-32
references: 22546379
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Urology. 2011 Nov;78(5):1089-94
references: 22054378
references: Urol Oncol. 2007 Jul-Aug;25(4):298-302
references: 17628295
references: N Engl J Med. 2011 Dec 15;365(24):2323-9
references: 22168647
references: J Urol. 2011 Nov;186(5):1779-85
references: 21944105
references: BJU Int. 2012 Jun;109(11):1607-13
references: 21939493
references: J Natl Cancer Inst. 2006 Sep 20;98(18):1331-4
references: 16985252
references: Cancer. 2010 May 15;116(10):2316-21
references: 20225227
references: J Urol. 2011 Jun;185(6):2072-7
references: 21496845
references: JAMA. 2012 Apr 4;307(13):1433-5
references: 22474208
references: Cancer. 2008 Jul 1;113(1):78-83
references: 18491376
references: Eur Urol. 2011 Apr;59(4):543-52
references: 21186077
references: J Urol. 2012 Mar;187(3):816-21
references: 22248514
references: BJU Int. 2013 May;111(5):731-8
references: 22502641
references: J Urol. 2011 Aug;186(2):394-9
references: 21679982
references: Urology. 2011 Jul;78(1):93-8
references: 21550636
references: BJU Int. 2012 Oct;110(8):1156-61
references: 22372984
references: J Urol. 2006 Mar;175(3 Pt 1):853-7; discussion 858
references: 16469564
references: J Urol. 2009 Oct;182(4):1271-9
references: 19683266
references: J Urol. 2009 Sep;182(3):844-53
references: 19616235
references: Eur Urol. 2010 Sep;58(3):398-406
references: 20633979
references: J Urol. 2012 Dec;188(6):2089-94
references: 23083877
references: Cancer. 2008 Jun;112(11):2456-66
references: 18428196
references: N Engl J Med. 2011 Mar 24;364(12):1090-1
references: 21428764