The effect of race and gender on the surgical management of the small renal mass

Background: To date, no population studies have been designed to assess the impact of race and gender on the rate of nephron-sparing surgery (NSS) across the United States. Materials and methods: The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients with T1a renal cell carcinoma (RCC) treated over the most recent decade, 1998-2007. Baseline socio-demographic data were compared between Caucasian and African-American patients using χ² and t-test analysis, and rates of radical nephrectomy (RN) were compared for all permutations of race and gender. A multivariate logistic regression model was in turn created with these variables to predict the odds of undergoing a radical nephrectomy. No prior assumptions were made regarding superiority of partial nephrectomy (PN) over RN as a therapeutic intervention. Results: A total of 14,953 patients were eligible for inclusion in this study, and of these, 1,804 (12%) were African-American. Comparably, African-American patients were younger (<50 years; 23 vs. 28%, P < 0.001), and had an increased rate of high grade disease (13 vs. 16%, P < 0.001). Among different subsets of race and gender, African-American women received PN least often (28%) compared with all other groups, with African-American women at a 47% increased risk of undergoing RN compared with Caucasian male counterparts (95% CI: 1.24-1.73). Conclusions: Significant racial and gender disparities exist with regard to utilization of nephron-sparing surgery for small renal masses, particularly in African-American women. Further efforts should be directed to elucidating and addressing the rationale behind this disparity to ensure the uniformity of care.