Mp45-15 impact of Preoperative Wait Time on Renal Cell Carcinoma Tumor Characteristics and Racial and Ethnic Disparities

Abstract

INTRODUCTION AND OBJECTIVE: Clinical T1a renal masses ( 4 cm) be managed by partial nephrectomy (PN), tumor ablation (TA), or with active surveillance (AS) for lesions under 3 cm. Safety net hospitals (SNH) may face constraints that impact the choice of treatment strategy. We examined trends in management of cT1a renal masses by SNH status using the National Cancer Database (NCDB). We hypothesized that patients treated at SNH would be more likely to undergo AS.METHODS: The NCDB was queried from 2010-2016 for adult patients with clinical T1aN0M0 renal mass. We excluded patients with multiple cancer diagnoses, and lacking treatment data (AS, TA, PN, or radical nephrectomy). SNH status has been previously defined as a hospital with >30% of patients are Medicaid-funded or uninsured. Demographic and hospital characteristics were compared by SNH status. A multivariate logistic regression model was constructed to determine odds of undergoing AS by SNH status. Kaplan Meier analysis and Cox hazards models evaluated association between overall mortality and SNH status.RESULTS: 59,861 patients met inclusion criteria. Of these, SNH only accounted for 1.8% (n [ 1,051) of reported cases. Patients with cT1a renal masses at SNH were younger [mean(SD) 55 ( 12) vs 60 (13), p<0.01], non-white (41% vs 17%), from the lowest income quartile (32% vs 13%, p<0.01), and treated in the South (56% vs 38%, p<0.01). There was no difference in Charlson comorbidity index (CCI), gender, or treatment year between groups. On multivariate analysis, SNH status predicted increased odds of undergoing AS compared to non-safety net hospitals (OR: 2.2, p<0.01). Black patients (OR: 1.6, p<0.01), non-private insurance (OR: 1.3, p<0.01), and greater CCI scores (OR: 1.2, p<0.01) predicted greater odds of AS. Highest income quartile (OR: 0.8, p<0.01) predicted higher rates of intervention. There was no difference in survival by SNH status.CONCLUSIONS: While current guidelines recommend PN, TA, or AS for cT1a renal masses, our study suggests that hospital resources may influence the treatment strategy. Patients at safety net hospitals were more likely to undergo AS despite being younger, and having no difference in comorbidity compared to patients at non-safety net hospitals. White patients, those with private insurance, and patients in the highest income quartile were more likely to receive procedural intervention. Future studies should focus on both patient and hospital factors, including limited operating room and surgeon availability, that could impact treatment decisions.