PMID- 28503232
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 1911-6470 (Print)
IS  - 1920-1214 (Electronic)
IS  - 1911-6470 (Linking)
VI  - 11
IP  - 5
DP  - 2017 May
TI  - Cytoreductive nephrectomy in the modern era: Predictors of use, morbidity, and 
      survival.
PG  - E184-E191
LID - 10.5489/cuaj.4137 [doi]
AB  - INTRODUCTION: To determine tumour, patient, and provider factors associated with 
      cytoreductive nephrectomy (CN) use and to identify those factors that predicted 
      short-term and long-term surgical outcomes. METHODS: We performed a retrospective 
      review (1998-2011) of the National Cancer Database, a U.S. population-based 
      oncology outcomes database. The review included 36 549 patients with metastatic 
      renal cell carcinoma (mRCC). We assessed predictors of CN use, length of stay 
      (LOS), 30-day readmission, and 30-day mortality using multivariable logistic 
      regression. The Cox proportional hazards model assessed predictors of overall 
      survival (OS). RESULTS: Overall, 10 809 (29.6%) patients received CN, increasing 
      from 15.2% to 36.1% over time. Private insurance (odds ratio [OR] 1.26; 95% 
      confidence interval [CI] 1.16-1.37) and academic facilities (OR 1.83; 95% CI 
      1.68-1.99) were associated with receiving CN (p<0.0001). Charlson score >/=2 and 
      older age group were less likely to undergo surgery (p<0.0001). Median LOS was 
      five days (inter-quartile range [IQR] 3-7), while 30-day readmission and 30-day 
      mortality were 5.3% and 3.3%, respectively. Undergoing CN (hazard ratio [HR] 
      0.48; 95% CI 0.44-0.52; p<0.0001) and treatment at academic centres (HR 0.88; 95% 
      CI 0.81-0.95; p=0.001) were independently associated with improved OS. Limitation 
      includes retrospective design with possible selection bias. CONCLUSIONS: 
      Increased CN use continues in the modern era, with relatively low surgical 
      morbidity. Further study is required to determine if the finding of lower 
      all-cause mortality in patients treated at academic centres is due to improved 
      care or unmeasured confounders.
FAU - Minnillo, Brian J
AU  - Minnillo BJ
AD  - Urological Institute, University Hospitals Case Medical Centre, Case Western 
      Reserve University, Cleveland, OH, United States.
FAU - Tabayoyong, William
AU  - Tabayoyong W
AD  - Urological Institute, University Hospitals Case Medical Centre, Case Western 
      Reserve University, Cleveland, OH, United States.
FAU - Francis, John J
AU  - Francis JJ
AD  - Urological Institute, University Hospitals Case Medical Centre, Case Western 
      Reserve University, Cleveland, OH, United States.
FAU - Maurice, Matthew J
AU  - Maurice MJ
AD  - Urological Institute, University Hospitals Case Medical Centre, Case Western 
      Reserve University, Cleveland, OH, United States.
FAU - Zhu, Hui
AU  - Zhu H
AD  - Urology Section/Surgery Service, Louis Stokes Cleveland Veterans Affairs Medical 
      Centre, Cleveland, OH, United States.
FAU - Kim, Simon
AU  - Kim S
AD  - Urological Institute, University Hospitals Case Medical Centre, Case Western 
      Reserve University, Cleveland, OH, United States.
FAU - Abouassaly, Robert
AU  - Abouassaly R
AD  - Urological Institute, University Hospitals Case Medical Centre, Case Western 
      Reserve University, Cleveland, OH, United States.
LA  - eng
PT  - Journal Article
DEP - 20170509
PL  - Canada
TA  - Can Urol Assoc J
JT  - Canadian Urological Association journal = Journal de l'Association des urologues 
      du Canada
JID - 101312644
PMC - PMC5426939
COIS- Competing interests: The authors report no competing personal or financial 
      interests.
EDAT- 2017/05/16 06:00
MHDA- 2017/05/16 06:01
PMCR- 2017/05/01
CRDT- 2017/05/16 06:00
PHST- 2017/05/16 06:00 [entrez]
PHST- 2017/05/16 06:00 [pubmed]
PHST- 2017/05/16 06:01 [medline]
PHST- 2017/05/01 00:00 [pmc-release]
AID - cuaj-5-e184 [pii]
AID - 10.5489/cuaj.4137 [doi]
PST - ppublish
SO  - Can Urol Assoc J. 2017 May;11(5):E184-E191. doi: 10.5489/cuaj.4137. Epub 2017 May 
      9.