Open Access

ARTICLE

Factors associated with surgical refusal and non-surgical candidacy in stage 1 kidney cancer: a National Cancer Database (NCDB) analysis

Kennedy E. Okhawere¹, Ralph Grauer¹, Indu Saini¹, Iretiayo T. Joel¹, Alp Tuna Beksac², Oluwatoyin Ayo-Farai¹, Rutul Patel¹, Talia G. Korn¹, Kirolos N. Meilika¹, Najimdin Pedro¹, Ketan K. Badani¹

1 Icahn School of Medicine at Mount Sinai, New York, New York, USA
2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
Address correspondence to Dr. Kennedy Okhawere, Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY 10029 USA

Canadian Journal of Urology 2024, 31(5), 11992-12003.

Abstract

Introduction: 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).
Materials and methods: 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.
Results: 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).
Conclusion: 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.

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