Race and sex disparities in the treatment of older patients with T1a renal cell carcinoma: a comorbidity-controlled competing-risks model.
Race and sex disparities in the treatment of older patients with T1a renal cell carcinoma: a comorbidity-controlled competing-risks model.
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DOI：
10.1016/j.urolonc.2014.01.002
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发表时间：
2014-07
期刊：
影响因子：
--
通讯作者：
Allaf ME
中科院分区：
文献类型：
--
作者：
Patel HD;Kates M;Pierorazio PM;Allaf ME
Recognizing population-level disparities for the treatment of patients with renal cell carcinoma (RCC) will inform clinical practice and health policy. Few studies, reporting conflicting results, have investigated race and sex disparities specifically among patients with small renal masses. The Surveillance, Epidemiology and End Results-Medicare database (1995–2007) was queried for patients with localized T1a RCC undergoing radical nephrectomy, partial nephrectomy (PN), or deferred therapy (DT). Demographics, comorbidity, and treatment approach were assessed. Multivariable logistic regression models evaluated predictors of DT, and then PN among those receiving surgery. Cox proportional hazards evaluated survival differences for whites vs. blacks and women vs. men. A total of 6092 white and 617 black patients with T1a RCC met the inclusion criteria. Blacks were twice as likely to defer therapy compared to whites (odds ratio (OR) 1.95 (95% confidence interval (CI) 1.52–2.51)) and had worse overall survival (hazard ratio (HR) 1.36 (95%CI 1.19–1.56)). However, cancer-specific survival (CSS) was similar (p=0.429). The greatest discrepancy was among healthy (CCI≤1) blacks who had a much higher rate of DT compared to their white counterparts. Women were found to have decreased utilization of PN compared to men (OR 0.84 (95%CI 0.74–0.96)) and better CSS (HR 0.74 (95%CI 0.58–0.94)), but there were no differences by race. The differential utilization of DT by race instead of purely by age and comorbidity is concerning but has not led to a significant difference in CSS. Women are less likely to undergo PN compared to men, but they also have a notably improved CSS.
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