Trends in the use of partial nephrectomy for cT1 renal tumors: Analysis of a 10-yr European multicenter dataset.
OBJECTIVE
Although extensively addressed in US registries, the utilization rate of Partial Nephrectomy has been poorly addressed in European settings. Our aim is to evaluate the impact of hospital volume on the use of PN for cT1 renal tumors.


METHODS
2526 patients with cT1N0M0 renal tumors treated with either PN or radical nephrectomy at 10 European centres in the last decade were included in the analysis. Joinpoint regression analysis was used to identify significant changes over time in linear slope of the trend for each center. The correlation between yearly caseload and the slopes was assessed with the non-parametric Spearman test. Coincident pairwise tests and regression analyses were used to generate and compare the trends of high-volume (HV), mid-volume (MV) and low-volume (LV) groups.


RESULTS
Yearly caseload was significantly associated with increased use of PN (R = 0.69, p = 0.028). The utilization rate of PN was stable at LV centres (p = 0.67, p = 0.7, p = 0.76, for cT1, cT1a, and cT1b tumors, respectively), while increased significantly at MV (p = 0.002, 0.0005 and 0.007, respectively) and HV centers (all p < 0.0001). Regression analysis confirmed the trends for HV and MV as significantly different from those observed in LV centres (all p ≤ 0.002) and highlighted significant differences also between MV and HV centres (all p ≤ 0.03).


CONCLUSIONS
We confirmed the association between caseload and the use of PN for cT1 tumors. Our findings suggest that a minimum caseload might turn the tide also in LV centres while a selective referral to HV centers for cT1b tumors should be considered.
"Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: puldet@gmail.com.
G
G
Simone
"Sant'Andrea" Hospital, Sapienza University, Rome, Italy.
C
C
De Nunzio
"Regina Elena" National Cancer Institute, Rome, Italy.
M
M
Ferriero
(")Padre Pio da Pietrelcina" Hospital, Vasto, Italy.
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L
Cindolo
Ludwig-Maximilians-University, Munich, Germany.
S
S
Brookman-May
"Campus Biomedico" University, Rome, Italy.
R
R
Papalia
"Regina Elena" National Cancer Institute, Rome, Italy.
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I
Sperduti
(")San Giovanni Bosco" Hospital, Turin, Italy.
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D
Collura
"Regina Elena" National Cancer Institute, Rome, Italy; Policlinico Umberto I, Sapienza University, Rome, Italy.
C
C
Leonardo
"Regina Elena" National Cancer Institute, Rome, Italy.
U
U
Anceschi
"Regina Elena" National Cancer Institute, Rome, Italy; Policlinico Umberto I, Sapienza University, Rome, Italy.
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G
Tuderti
"Regina Elena" National Cancer Institute, Rome, Italy; Policlinico Umberto I, Sapienza University, Rome, Italy.
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L
Misuraca
Medical University of Graz, Graz, Austria.
O
O
Dalpiaz
Medical University of Graz, Graz, Austria.
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S
Hatzl
Bolzano General Hospital, Bolzano, Italy.
M
M
Lodde
Bolzano General Hospital, Bolzano, Italy.
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E
Trenti
"Sapienza University", ICOT, Latina, Italy.
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AL
Pastore
"Sapienza University", ICOT, Latina, Italy.
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G
Palleschi
G. Rummo Hospital, Benevento, Italy.
G
G
Lotrecchiano
G. Rummo Hospital, Benevento, Italy.
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L
Salzano
"Sapienza University", ICOT, Latina, Italy.
A
A
Carbone
European Institute of Oncology, Milan, Italy.
O
O
De Cobelli
"Sant'Andrea" Hospital, Sapienza University, Rome, Italy.
A
A
Tubaro
(")Padre Pio da Pietrelcina" Hospital, Vasto, Italy.
L
L
Schips
Medical University of Graz, Graz, Austria.
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R
Zigeuner
University Jean Monnet, Saint Etienne, France.
J
J
Tostain
St. Elisabeth Hospital Straubing, Germany.
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M
May
"Regina Elena" National Cancer Institute, Rome, Italy.
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S
Guaglianone
"Campus Biomedico" University, Rome, Italy.
G
G
Muto
"Regina Elena" National Cancer Institute, Rome, Italy.
M
M
Gallucci
D066264:Datasets as Topic; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies
Kidney cancer; Outcomes; Partial nephrectomy; Temporal trends