title: National treatment trends among older patients with T1-localized renal cell carcinoma.
abstract: To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy.
  
  
  
  Using the National Cancer Database, we identified older patients (≥70y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment-partial nephrectomy (PN), radical nephrectomy, EM, and ablation. Multivariable logistic regression analysis stratified by tumor size (<2, 2-3.9, or 4-7cm) and age groups (70-79 and ≥80y) was used to identify covariates associated with different treatments.
  
  
  
  Among 41,518 older patients with T1 renal cell carcinoma renal tumors, most were treated with radical nephrectomy (59.0%) followed by PN (20.0%) and ablation (8.4%). Only 12.6% were managed by EM. Among older patients aged 70 to 79 years with renal tumors 2 to 3.9cm, PN was used more frequently in 2008 to 2009 (odds ratio [OR] = 1.32; P = 0.001) and 2010 to 2011 (OR = 1.87; P<0.001) compared to 2002 to 2003 and at academic hospitals (OR = 1.91; P<0.001) compared to community hospitals. Similar trends were observed for patients aged 70 to 79 years with 4 to 7cm tumors and for patients aged≥80 years across renal tumor sizes.
  
  
  
  Among older patients with localized renal tumors and limited life expectancy, most are treated surgically with a growing use of PN. A smaller proportion of older patients are managed by EM in the United States.
authors.affiliation: Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Cleveland Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH; Cancer Outcomes Public Policy and Effectiveness Research (COPPER), Yale University, New Haven, CT. Electronic address: simkim@me.com.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Cancer Outcomes Public Policy and Effectiveness Research (COPPER), Yale University, New Haven, CT; Department of Medicine, Yale University, New Haven, CT.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Neal
authors.initials: N
authors.lastname: Meropol
authors.affiliation: Division of Urologic Oncology, Philadelphia, PA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.affiliation: Division of Urologic Oncology, Philadelphia, PA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Yale University, New Haven, CT.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Division of Urologic Surgery, Cook County Health and Hospitals Systems, Chicago, IL.
authors.forename: Sarah
authors.initials: S
authors.lastname: Psutka
authors.affiliation: Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Kiechle
authors.affiliation: Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
mesh_terms: D055011:Ablation Techniques / Q000639:trends*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008017:Life Expectancy; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States; D057832:Watchful Waiting / Q000639:trends*
keywords: Advanced age; Kidney cancer; Nephrectomy; Renal cell carcinoma; Treatment decisions