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. 2023;107(4):396-405.
doi: 10.1159/000528559. Epub 2023 Jan 26.

Focal Therapy for Renal Cancer: Comparative Trends in the USA and Germany from 2006 to 2020 and Analysis of the German Health Care Landscape

Luka Flegar  1 , Smita George Thoduka  2 , Andreas H Mahnken  2 , Jens Figiel  2 , Hendrik Heers  1 , Cem Aksoy  1 , Nicole Eisenmenger  3 , Christer Groeben  1 , Johannes Huber  1 , Aristeidis Zacharis  1
Affiliations

Focal Therapy for Renal Cancer: Comparative Trends in the USA and Germany from 2006 to 2020 and Analysis of the German Health Care Landscape

Luka Flegar et al. Urol Int. 2023.

Abstract

Introduction: The aim of the study was to investigate trends of FT for in-patient treatment of renal RCC in the USA and Germany.

Methods: We analyzed the SEER database for the USA and the nationwide German hospital billing database each from 2006 to 2019 for a RCC diagnosis in combination with FT, radical nephrectomy, and partial nephrectomy. FT was defined as radiofrequency ablation (RFA) or cryotherapy. Linear regression analysis was performed to detect changes over time.

Results: For the USA, we included 7,318 FT cases. The share of FT increased from 2.4% in 2006 to 6.4% in 2019 (p < 0.001). For Germany, we identified 2,920 FT cases. The share of FT increased from 0.7% in 2006 to 2.0% in 2019 (p < 0.001). The number of RFAs in the USA steadily increased by 227% from a total of 93 in 2006 to 304 in 2019 while the number of cryotherapies in the USA steadily increased by 289% from a total of 127 in 2006 to 494 in 2019 (p < 0.001). The number of RFAs in Germany increased by 344% from a total of 59 in 2006 to 262 in 2019 (p < 0.001) while the number of cryotherapies steadily increased by 43% from a total of 54 in 2006 to 77 in 2019 (p < 0.001). In Germany, RFA is significantly more performed than cryotherapy while in the USA cryotherapy is more frequently applied.

Conclusion: We observed a constant increase of FT in the USA and Germany for RCC in-patient treatment with a higher share in the USA.

Keywords: Ablation techniques; Focal therapy; Kidney; Population-based study; Renal cell carcinoma; Trends.

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Conflict of interest statement

Luka Flegar certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership, expert testimony, royalties, or patents filed, received, or pending), are the following: none. N. Eisenmenger is founder and director of RI Innovation GmbH. J. Huber is managing director of the Urologische Stiftung Gesundheit gGmbH and indicates support of scientific projects outside the submitted work by Intuitive Surgical, Takeda, Janssen, and Coloplast. All the other authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Share of performed therapies for renal tumors in the USA (a) and Germany (b) (source: SEER database and Destatis data).
Fig. 2.
Fig. 2.
Overview of performed RFA in 2006 (a) and 2020 (b) in Germany (source: German hospitals' quality reports).
Fig. 3.
Fig. 3.
RFA (a) and cryotherapy (b) annual procedures in 2006 and 2020 by share of centers per category (source: German hospitals' quality reports).
Fig. 4.
Fig. 4.
Overview of performed cryotherapy in 2006 (a) and 2020 (b) in Germany (source: German hospitals' quality reports).
Fig. 5.
Fig. 5.
RFA (a) and cryotherapy (b) in 2020 stratified by age distribution (source: German hospitals' quality reports).
Fig. 6.
Fig. 6.
Overview of trends for RCC treatment from 2006 to 2019 (source: Destatis data).
See this image and copyright information in PMC

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