title: Adherence to guideline recommendations for management of clinical T1 renal cancers in the Netherlands: a population-based study.
abstract: OBJECTIVE
  For decades, small renal cancers are treated by radical nephrectomy (RN). Current guidelines recommend partial nephrectomy (PN) to preserve renal function and minimize cardiovascular comorbidity. As adherence to guidelines is largely unknown and international comparison to evaluate quality of health care is lacking, an pre-specified guideline evaluation of quality indicators concerning management of cT1 renal cancers was performed.
  
  
  METHODS
  We performed a cohort study including patients with cT1 renal cancer between 2010 and 2014, identified through the Netherlands Cancer Registry. Time trends and variation in treatment were described. Factors associated with PN in cT1a and laparoscopic RN in cT1b were evaluated with logistic regression analyses.
  
  
  RESULTS
  An increase in nephron-sparing treatment strategies (NSS) of cT1a patients (N total = 2436) was observed; in 2014, 67 % underwent NSS (62 % PN and 5 % thermal ablation). Age, a non-central tumor localization and being treated in a high-volume hospital were associated with PN. Although NSS were applied more frequently over time, the majority (70 %) of cT1b patients (N total = 2205) underwent RN in 2014, mainly performed laparoscopically. Increasing tumor size, tumor localization in the right kidney and being treated in a university hospital were associated with a lower probability of a laparoscopic RN versus open. Treatment in a high-volume hospital was associated with a higher probability of laparoscopic RN.
  
  
  CONCLUSIONS
  Dutch patients with cT1 renal cancer are predominantly treated according to current guidelines. Data of this pre-specified quality indicator analysis of a urological national guideline may serve as a model for international comparison of treatment of cT1 renal cancers.
authors.affiliation: Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands. K.Aben@iknl.nl.|Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. K.Aben@iknl.nl.|Netherlands Comprehensive Cancer Organisation, P.O. Box 1281, 6501 BG, Nijmegen, The Netherlands. K.Aben@iknl.nl.
authors.forename: Katja K H
authors.initials: KK
authors.lastname: Aben
authors.affiliation: Department of Oncology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Susanne
authors.initials: S
authors.lastname: Osanto
authors.affiliation: Department of Pathology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Hulsbergen-van de Kaa
authors.affiliation: Department of Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Soetekouw
authors.affiliation: Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
authors.forename: Daphne
authors.initials: D
authors.lastname: Stemkens
authors.affiliation: Department of Urology, Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
mesh_terms: D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D019983:Guideline Adherence; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000592:standards; D009426:Netherlands
keywords: Cancer registry; Guideline adherence; Kidney cancer; Partial nephrectomy; Population-based