@Article{,
AUTHOR = {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},
TITLE = {Factors associated with surgical refusal and non-surgical candidacy in stage 1 kidney cancer: a National Cancer Database (NCDB) analysis},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {31},
YEAR = {2024},
NUMBER = {5},
PAGES = {11992--12003},
URL = {http://www.techscience.com/CJU/v31n5/59563},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> 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).<br/>
<b>Materials and methods:</b> 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.<br/>
<b>Results:</b> 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).<br/>
<b>Conclusion:</b> 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.},
DOI = {}
}