title: Gender disparity in kidney cancer treatment: women are more likely to undergo radical excision of a localized renal mass.
abstract: OBJECTIVE
  To investigate gender effects on the type of nephrectomy performed for a stage I renal mass and differences that might account for disparity in treatment patterns according to gender.
  
  
  METHODS
  Using a single-institution database, patients who underwent nephrectomy at a tertiary referral center for a localized, solitary tumor, ≤ 7 cm with a normal contralateral kidney were identified. Variables thought to affect selection for type of nephrectomy were compared between male and female patients. Using multivariable logistic regression, the effect of gender on the likelihood of radical vs partial nephrectomy and the likelihood of malignancy were assessed. Renal function outcomes were also compared.
  
  
  RESULTS
  No difference between genders was seen in age, race, smoking status, body mass index, tumor size, RENAL score or operating surgeon. Only Charlson index and preoperative creatinine significantly differed with women having a more favorable comorbidity profile (Charlson >1 in 38% vs 50%; P = .027) and lower mean preoperative creatinine (0.09 ± 0.3 vs 1.1 ± 0.3; P <.001). Despite lower creatinine, women had inferior preoperative renal function with a mean estimated glomerular filtration rate of 71.4 ± 21 vs 78.9 ± 21 mL/min/1.73 m2 in men (P <.001). Multivariable analysis indicated that female patients were 2.5 times more likely to undergo radical nephrectomy compared with their male counterparts (P = .022). Women were less likely to have malignancy (odds ratio male gender 2.50; P = .013).
  
  
  CONCLUSIONS
  Women are more likely than men to undergo radical vs partial excision of a localized renal mass, despite less comorbid burden, inferior renal function, and increased likelihood of benign disease.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: O'Malley
authors.forename: Willie
authors.initials: W
authors.lastname: Underwood
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Brewer
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Hayn
authors.forename: Hyung L
authors.initials: HL
authors.lastname: Kim
authors.forename: Diana C
authors.initials: DC
authors.lastname: Mehedint
authors.forename: Mohab W
authors.initials: MW
authors.lastname: Safwat
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwaab
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003404:Creatinine / Q000652:urine; D003657:Decision Making; D005260:Female; D005919:Glomerular Filtration Rate; D054625:Healthcare Disparities; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000601:surgery; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D012044:Regression Analysis; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine