National Trends of Local Ablative Therapy Among Young Patients With Small Renal Masses in the United States.
OBJECTIVE
To assess national trends in the usage of local ablative therapy for small renal masses (SRMs) in a cohort of young patients. Ablation of SRMs has been shown to offer cancer control with limited follow-up. Although ablation is considered effective for patients with limited life expectancy, its use among younger patients may be considered controversial.


METHODS
We used the National Cancer Data Base to identify patients between the ages of 40 and 65 years who were diagnosed with SRMs from 2004 to 2011. The primary outcome was the use of local ablative therapy. Multivariable logistic regression analysis was used to identify patient and hospital factors associated with ablation therapies in this cohort.


RESULTS
During the study period, we identified 49,441 patients with SRMs, of which 2789 (5.6%) were treated with ablative therapies. The proportion of patients undergoing ablation gradually rose from 2.2% in 2004 to 6.2% in 2011 (P < .001). On multivariable analysis, patients were more likely to receive local ablation at academic hospitals (odds ratio [OR]: 1.5; P < .001) compared with community hospitals, or primarily insured by Medicaid (OR: 1.4; P < .001) or Medicare (OR: 1.3; P < .001) compared with private insurance.


CONCLUSIONS
The use of local ablative therapies is gradually rising but has so far been limited to a small fraction of young patients with SRMs. Patients treated at high-volume, academic hospitals or insured with Medicaid or Medicare were treated to a greater degree with ablation. These results have important implications for the adoption of ablation and the need for long-term surveillance.
Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
Jonathan E
JE
Kiechle
Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Center for Health Care Quality and Research, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
Robert
R
Abouassaly
Department of Urology, Fox Chase Cancer Center, Philadelphia, PA.
Marc C
MC
Smaldone
Division of Health Policy and Research, Mayo Clinic, Rochester, MN.
Nilay D
ND
Shah
Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
Shan
S
Dong
Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
Edward E
EE
Cherullo
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Department of Radiology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
Dean
D
Nakamoto
Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH.
Hui
H
Zhu
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Department of Medical Oncology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
Matthew M
MM
Cooney
Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Center for Health Care Quality and Research, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: simkim@me.com.
Simon P
SP
Kim
D000328:Adult; D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods / Q000639:trends*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D018570:Risk Assessment; D018426:SEER Program; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States