title: Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer.
abstract: OBJECTIVE
  Although kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health.
  
  
  RESULTS
  From 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, P<0.001). Over the study interval, rates of PN (AAPC = 13.1%, P<0.001) increased substantially, becoming the most used treatment by 2010. Among the elderly, rates of nonoperative management and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001).
  
  
  CONCLUSIONS
  As the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors.
authors.affiliation: VA/UCLA Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA; Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, CA. Electronic address: htan@mednet.ucla.edu.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, CA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: Institute of Urologic Oncology, Department of Urology, University of California, Los Angeles, CA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018426:SEER Program; D055815:Young Adult
keywords: Aged; Epidemiology; Kidney neoplasm; Nephrectomy