Trends in the use of cytoreductive nephrectomy in the united states

Che Kai Tsao, Alexander C. Small, Erin L. Moshier, Benjamin A. Gartrell, Juan P. Wisnivesky, Guru Sonpavde, James H. Godbold, Michael A. Palese, Simon J. Hall, William K. Oh, Matthew D. Galsky

Research output: Contribution to journalArticle

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Abstract

Background: Two randomized trials published in 2001 established CyNx for patients with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era. However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR TKIs. We evaluated the patterns of use of CyNx from 2000 to 2008. Materials and Methods: The National Cancer Database was queried for patients diagnosed with mRCC. Patients who underwent CyNx were identified and were further categorized by pre-VEGFR versus VEGFR TKI era, race, insurance status, and hospital. For these subcategories, prevalence ratios (PRs) were generated using the proportion of patients with mRCC undergoing CyNx versus those not undergoing CyNx. Results: Of the 47,417 patients (pts) identified with mRCC, the prevalence of cytoreductive nephrectomy increased 3% each year from 2000 to 2005 (P <.0001), then decreased 3% each year from 2005 to 2008 (P =.0048), with a significant difference between the eras (0.97 vs. 1.025; P <.0001). Black and Hispanic pts were less likely than Caucasian pts to undergo CyNx. Pts with Medicaid, Medicare, and no insurance were less likely than pts with private insurance to undergo CyNx. Pts diagnosed at community hospitals were significantly less likely than pts at teaching hospitals to undergo CyNx. Conclusion: The use of CyNx has declined in the VEGFR-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the VEGFR-TKI era are awaited to optimize use of this modality and address potential disparities.

Original languageEnglish (US)
Pages (from-to)159-163
Number of pages5
JournalClinical Genitourinary Cancer
Volume10
Issue number3
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Nephrectomy
Carcinoma
Kidney
Insurance
Insurance Coverage
Community Hospital
Medicaid
Medicare
Hispanic Americans
Teaching Hospitals
Databases
Cytokines
Therapeutics

Keywords

  • Kidney cancer
  • Renal cell carcinoma
  • Socioeconomic differences
  • Tyrosine kinase inhibitor

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Tsao, C. K., Small, A. C., Moshier, E. L., Gartrell, B. A., Wisnivesky, J. P., Sonpavde, G., ... Galsky, M. D. (2012). Trends in the use of cytoreductive nephrectomy in the united states. Clinical Genitourinary Cancer, 10(3), 159-163. https://doi.org/10.1016/j.clgc.2012.03.008

Trends in the use of cytoreductive nephrectomy in the united states. / Tsao, Che Kai; Small, Alexander C.; Moshier, Erin L.; Gartrell, Benjamin A.; Wisnivesky, Juan P.; Sonpavde, Guru; Godbold, James H.; Palese, Michael A.; Hall, Simon J.; Oh, William K.; Galsky, Matthew D.

In: Clinical Genitourinary Cancer, Vol. 10, No. 3, 09.2012, p. 159-163.

Research output: Contribution to journalArticle

Tsao, CK, Small, AC, Moshier, EL, Gartrell, BA, Wisnivesky, JP, Sonpavde, G, Godbold, JH, Palese, MA, Hall, SJ, Oh, WK & Galsky, MD 2012, 'Trends in the use of cytoreductive nephrectomy in the united states', Clinical Genitourinary Cancer, vol. 10, no. 3, pp. 159-163. https://doi.org/10.1016/j.clgc.2012.03.008
Tsao, Che Kai ; Small, Alexander C. ; Moshier, Erin L. ; Gartrell, Benjamin A. ; Wisnivesky, Juan P. ; Sonpavde, Guru ; Godbold, James H. ; Palese, Michael A. ; Hall, Simon J. ; Oh, William K. ; Galsky, Matthew D. / Trends in the use of cytoreductive nephrectomy in the united states. In: Clinical Genitourinary Cancer. 2012 ; Vol. 10, No. 3. pp. 159-163.
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abstract = "Background: Two randomized trials published in 2001 established CyNx for patients with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era. However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR TKIs. We evaluated the patterns of use of CyNx from 2000 to 2008. Materials and Methods: The National Cancer Database was queried for patients diagnosed with mRCC. Patients who underwent CyNx were identified and were further categorized by pre-VEGFR versus VEGFR TKI era, race, insurance status, and hospital. For these subcategories, prevalence ratios (PRs) were generated using the proportion of patients with mRCC undergoing CyNx versus those not undergoing CyNx. Results: Of the 47,417 patients (pts) identified with mRCC, the prevalence of cytoreductive nephrectomy increased 3{\%} each year from 2000 to 2005 (P <.0001), then decreased 3{\%} each year from 2005 to 2008 (P =.0048), with a significant difference between the eras (0.97 vs. 1.025; P <.0001). Black and Hispanic pts were less likely than Caucasian pts to undergo CyNx. Pts with Medicaid, Medicare, and no insurance were less likely than pts with private insurance to undergo CyNx. Pts diagnosed at community hospitals were significantly less likely than pts at teaching hospitals to undergo CyNx. Conclusion: The use of CyNx has declined in the VEGFR-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the VEGFR-TKI era are awaited to optimize use of this modality and address potential disparities.",
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AU - Tsao, Che Kai

AU - Small, Alexander C.

AU - Moshier, Erin L.

AU - Gartrell, Benjamin A.

AU - Wisnivesky, Juan P.

AU - Sonpavde, Guru

AU - Godbold, James H.

AU - Palese, Michael A.

AU - Hall, Simon J.

AU - Oh, William K.

AU - Galsky, Matthew D.

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N2 - Background: Two randomized trials published in 2001 established CyNx for patients with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era. However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR TKIs. We evaluated the patterns of use of CyNx from 2000 to 2008. Materials and Methods: The National Cancer Database was queried for patients diagnosed with mRCC. Patients who underwent CyNx were identified and were further categorized by pre-VEGFR versus VEGFR TKI era, race, insurance status, and hospital. For these subcategories, prevalence ratios (PRs) were generated using the proportion of patients with mRCC undergoing CyNx versus those not undergoing CyNx. Results: Of the 47,417 patients (pts) identified with mRCC, the prevalence of cytoreductive nephrectomy increased 3% each year from 2000 to 2005 (P <.0001), then decreased 3% each year from 2005 to 2008 (P =.0048), with a significant difference between the eras (0.97 vs. 1.025; P <.0001). Black and Hispanic pts were less likely than Caucasian pts to undergo CyNx. Pts with Medicaid, Medicare, and no insurance were less likely than pts with private insurance to undergo CyNx. Pts diagnosed at community hospitals were significantly less likely than pts at teaching hospitals to undergo CyNx. Conclusion: The use of CyNx has declined in the VEGFR-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the VEGFR-TKI era are awaited to optimize use of this modality and address potential disparities.

AB - Background: Two randomized trials published in 2001 established CyNx for patients with metastatic renal carcinoma (mRCC) as a treatment standard in the cytokine era. However, first-line systemic therapy for mRCC changed in 2005 with FDA approval of VEGFR TKIs. We evaluated the patterns of use of CyNx from 2000 to 2008. Materials and Methods: The National Cancer Database was queried for patients diagnosed with mRCC. Patients who underwent CyNx were identified and were further categorized by pre-VEGFR versus VEGFR TKI era, race, insurance status, and hospital. For these subcategories, prevalence ratios (PRs) were generated using the proportion of patients with mRCC undergoing CyNx versus those not undergoing CyNx. Results: Of the 47,417 patients (pts) identified with mRCC, the prevalence of cytoreductive nephrectomy increased 3% each year from 2000 to 2005 (P <.0001), then decreased 3% each year from 2005 to 2008 (P =.0048), with a significant difference between the eras (0.97 vs. 1.025; P <.0001). Black and Hispanic pts were less likely than Caucasian pts to undergo CyNx. Pts with Medicaid, Medicare, and no insurance were less likely than pts with private insurance to undergo CyNx. Pts diagnosed at community hospitals were significantly less likely than pts at teaching hospitals to undergo CyNx. Conclusion: The use of CyNx has declined in the VEGFR-TKI era. In addition, racial and socioeconomic disparities exist in the use of CyNx. The results of pending randomized trials evaluating the role of CyNx in the VEGFR-TKI era are awaited to optimize use of this modality and address potential disparities.

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KW - Renal cell carcinoma

KW - Socioeconomic differences

KW - Tyrosine kinase inhibitor

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