Association of race and margin status among patients undergoing robotic partial nephrectomy for T1 renal cell carcinoma

Results from a population-based cohort

Victor S. Chen, Robert Abouassaly, Christopher M. Gonzalez, Alexander Kutikov, Marc C. Smaldone, Neal J. Meropol, Sarah P. Psutka, Stephen Williams, Rebecca O'Malley, Hillary M. Sedlacek, Simon P. Kim

    Research output: Contribution to journalArticle

    Abstract

    Objective: To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort. Methods: Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors. Results: Among 12,515 patients undergoing RPN in our cohort, 8.3% had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9%), we observed a higher proportion of PSM among African American (AA) (10.8%; P = 0.005) and Hispanic/Latino patients (8.8%; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4% vs. 6.9%; odds ratio = 1.57; P<0.001). Conclusions: In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race.

    Original languageEnglish (US)
    JournalUrologic Oncology: Seminars and Original Investigations
    DOIs
    StateAccepted/In press - 2017

    Fingerprint

    Robotics
    Nephrectomy
    Renal Cell Carcinoma
    Population
    African Americans
    Hispanic Americans
    Odds Ratio
    Neoplasms
    Margins of Excision
    Quality of Health Care
    Patient Selection
    Logistic Models
    Regression Analysis
    Databases
    Kidney

    Keywords

    • Healthcare Disparities
    • Kidney cancer
    • Positive margins
    • Race
    • Renal cell carcinoma
    • Robotic partial nephrectomy
    • Surgery

    ASJC Scopus subject areas

    • Oncology
    • Urology

    Cite this

    Association of race and margin status among patients undergoing robotic partial nephrectomy for T1 renal cell carcinoma : Results from a population-based cohort. / Chen, Victor S.; Abouassaly, Robert; Gonzalez, Christopher M.; Kutikov, Alexander; Smaldone, Marc C.; Meropol, Neal J.; Psutka, Sarah P.; Williams, Stephen; O'Malley, Rebecca; Sedlacek, Hillary M.; Kim, Simon P.

    In: Urologic Oncology: Seminars and Original Investigations, 2017.

    Research output: Contribution to journalArticle

    Chen, Victor S. ; Abouassaly, Robert ; Gonzalez, Christopher M. ; Kutikov, Alexander ; Smaldone, Marc C. ; Meropol, Neal J. ; Psutka, Sarah P. ; Williams, Stephen ; O'Malley, Rebecca ; Sedlacek, Hillary M. ; Kim, Simon P. / Association of race and margin status among patients undergoing robotic partial nephrectomy for T1 renal cell carcinoma : Results from a population-based cohort. In: Urologic Oncology: Seminars and Original Investigations. 2017.
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    abstract = "Objective: To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort. Methods: Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors. Results: Among 12,515 patients undergoing RPN in our cohort, 8.3{\%} had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9{\%}), we observed a higher proportion of PSM among African American (AA) (10.8{\%}; P = 0.005) and Hispanic/Latino patients (8.8{\%}; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4{\%} vs. 6.9{\%}; odds ratio = 1.57; P<0.001). Conclusions: In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race.",
    keywords = "Healthcare Disparities, Kidney cancer, Positive margins, Race, Renal cell carcinoma, Robotic partial nephrectomy, Surgery",
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    TY - JOUR

    T1 - Association of race and margin status among patients undergoing robotic partial nephrectomy for T1 renal cell carcinoma

    T2 - Results from a population-based cohort

    AU - Chen, Victor S.

    AU - Abouassaly, Robert

    AU - Gonzalez, Christopher M.

    AU - Kutikov, Alexander

    AU - Smaldone, Marc C.

    AU - Meropol, Neal J.

    AU - Psutka, Sarah P.

    AU - Williams, Stephen

    AU - O'Malley, Rebecca

    AU - Sedlacek, Hillary M.

    AU - Kim, Simon P.

    PY - 2017

    Y1 - 2017

    N2 - Objective: To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort. Methods: Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors. Results: Among 12,515 patients undergoing RPN in our cohort, 8.3% had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9%), we observed a higher proportion of PSM among African American (AA) (10.8%; P = 0.005) and Hispanic/Latino patients (8.8%; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4% vs. 6.9%; odds ratio = 1.57; P<0.001). Conclusions: In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race.

    AB - Objective: To assess the relationship of race and margin status among patients undergoing robotic partial nephrectomy (RPN) for T1 renal tumors from a contemporary population-based cohort. Methods: Using the National Cancer Database, we identified patients with localized renal cell carcinoma (RCC) (clinical T1N0M0) who underwent RPN from 2010 to 2013. The primary outcome was positive surgical margins (PSM). Multivariable logistic regression analyses were used to assess the association between race and PSM adjusting for patient clinicopathologic and hospital factors. Results: Among 12,515 patients undergoing RPN in our cohort, 8.3% had PSM (n = 1,045). When compared to white patients undergoing RPN for T1 RCC with PSM (7.9%), we observed a higher proportion of PSM among African American (AA) (10.8%; P = 0.005) and Hispanic/Latino patients (8.8%; P = 0.005), respectively. On multivariable analysis, AA patients had higher odds of PSM compared to white patients (odds ratio = 1.40; P = 0.008). Other factors associated with higher odds of PSM were treatment at nonacademic centers relative to academic centers (10.4% vs. 6.9%; odds ratio = 1.57; P<0.001). Conclusions: In this contemporary population-based cohort, AA patients undergoing RPN for localized RCC tumors are at higher risk for PSM. These results suggest potential differences in quality of care and patient selection of RPN by race.

    KW - Healthcare Disparities

    KW - Kidney cancer

    KW - Positive margins

    KW - Race

    KW - Renal cell carcinoma

    KW - Robotic partial nephrectomy

    KW - Surgery

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    U2 - 10.1016/j.urolonc.2017.07.011

    DO - 10.1016/j.urolonc.2017.07.011

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    JO - Urologic Oncology

    JF - Urologic Oncology

    SN - 1078-1439

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