We aim to identify factors associated with surgical refusal and non-surgical candidacy in clinical stage I kidney masses and to evaluate their impact on overall survival (OS).
We conducted a retrospective cohort study using the National Cancer Database of patients with clinical stage I kidney cancer between 2004 and 2017. Logistic regression was used to determine baseline sociodemographic-, clinical-, and treatment facility-related factors associated with surgical refusal and non-surgical candidacy. Patients were 1.1 propensity score-matched and Cox regression analysis evaluated the impact of surgical refusal and non-surgical candidacy on OS.
Compared to those who underwent surgery, those who refused surgery and those who were non-surgical candidates were more likely to be older, female, non-Hispanic (NH) Black, uninsured, have multiple comorbidities, and traveled a shorter distance to care. Similarly, compared to non-surgical candidates, those who refused surgery were more likely to be younger and have a tumor size ≥ 4.0 cm. Those who refused surgery had significantly lower median survival time and worse OS than those who underwent surgery (HR: 3.18, 95% CI: 2.85, 3.54). Non-surgical candidates had significantly lower median survival time and lower OS than those who had surgery (HR: 4.16, 95% CI: 3.84, 4.51).
Various socioeconomic, demographic, and clinical factors are associated with patients refusing to undergo surgery, which in turn leads to lower overall survival rates in stage I kidney cancer patients. Recognizing these factors will enable healthcare professionals to address and potentially alleviate these issues, ultimately ensuring that patients receive the most appropriate care.
The Canadian journal of urology. 2024 Oct [Epub]
Kennedy E Okhawere, Ralph Grauer, Indu Saini, Iretiayo T Joel, Alp Tuna Beksac, Oluwatoyin Ayo-Farai, Rutul Patel, Talia G Korn, Kirolos N Meilika, Najimdin Pedro, Ketan K Badani
Icahn School of Medicine at Mount Sinai, New York, New York, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.