Variation in surgical care for early-stage kidney cancer

描述（由申请人提供）：特殊的手术实践模式可能导致早期肾细胞癌（RCC）患者在腹腔镜和部分肾切除术（PN）的使用上出现不合理的变化。为了验证这一假设，我们将探讨以下具体目的：1)评估RCC患者使用腹腔镜手术的地理差异；2)表征肾细胞癌患者使用PN的地理差异；3)评估腹腔镜和PN使用之间的相互作用。来自SEER和Medicare的关联数据将用于确定1998年至2002年间诊断出的肾癌病例的全国样本。将计算并比较各个医院转诊地区的RCC特异性腹腔镜检查和PN年发病率的时间趋势，并根据相关协变量进行调整。使用腹腔镜和PN之间的相互作用将被先验地评估。该数据将为早期肾癌患者在腹腔镜和PN使用方面的不合理变化提供更精确的特征，并可能反过来激励患者、提供者和政策层面的干预措施，旨在使RCC的手术治疗更有效，更以患者为中心。

DESCRIPTION (provided by applicant): Idiosyncratic surgical practice patterns may contribute to unwarranted variation in the use of laparoscopy and partial nephrectomy (PN) among patients with early-stage renal cell carcinoma (RCC). In order to test this hypothesis, we will explore the following specific aims: 1) To evaluate geographic variation in the use of laparoscopic surgery among patients with RCC; 2) To characterize geographic variation in the use of PN among patients with RCC; and 3) To assess for an interaction between the use of laparoscopy and the use of PN. Linked data from SEER and Medicare will be used to identify a national sample of incident kidney cancer cases diagnosed between 1998 and 2002. Temporal trends in annual incidence rates for RCC- specific laparoscopy and PN will be calculated and compared for individual hospital referral regions, adjusted for relevant covariates. Interactions between the use laparoscopy and PN will be evaluated a priori. This data will provide more precise characterization of unwarranted variation in the use of laparoscopy and PN among patients with early-stage kidney cancer and may, in turn, motivate patient-, provider- and policy-level interventions aimed at making the surgical treatment of RCC both more effective and more patient-centered.