The following is a summary of “Urologist-level variation in the management of T1a renal cell carcinoma: A population-based cohort study,” published in the January 2024 issue of Urology by Cheaib et al.

This study addresses the considerable variability in managing small renal masses due to current guidelines’ lack of strict indications. The influence of urologists on the management approach for patients with small renal masses has yet to be previously explored. Using the linked Surveillance, Epidemiology, and End Results-Medicare database, researchers identified and assigned patients aged ≥66 years diagnosed with small renal masses between January 1, 2004, and December 31, 2013, to primary urologists. Employing mixed-effects logistic models, the study group assessed factors associated with diverse management approaches, estimated urologist-level probabilities for each approach, evaluated management variation and discerned the primary urologist’s impact on the approach choice. The study included 12,402 patients with 2,794 corresponding primary urologists. 

Notably, at the individual urologist level, case-adjusted probabilities of different approaches exhibited marked variation: nonsurgical management (mean, 12.8%; range, 4.9%–36.1%); thermal ablation (mean, 10.8%; range, 2.4%–66.3%); partial nephrectomy (mean, 30.1%; range, 10.1%–66.6%); and radical nephrectomy (mean, 40.4%; range, 17.7%–71.6%). In comparison to patient and tumor characteristics, the primary urologist emerged as a more influential factor, accounting for 13.6% (vs. 12.9%), 33.8% (vs. 2.1%), 15.1% (vs. 8.4%), and 13.5% (vs. 4.0%) of the variation in management choices for nonsurgical management, thermal ablation, partial nephrectomy, and radical nephrectomy, respectively. 

The study’s conclusions highlight the substantial variation in managing small renal masses, primarily driven by urologist preference and practice patterns. These findings underscore the imperative for unified guidance to mitigate unwarranted variation in care for patients with small renal masses.

 Source: sciencedirect.com/science/article/abs/pii/S1078143924000127