OBJECTIVE: To examine temporal, geographic, socioeconomic, and clinical determinants of cytoreductive nephrectomy (CNT) use in the surveillance, epidemiology, and end results (SEER) database, because CNT is known to improve survival in patients with metastatic renal cell carcinoma (mRCC). METHODS: Within the SEER database, we identified 6226 mRCC patients, who were either treated with CNT (n = 2038) or underwent no surgery (n = 4188) between 1989 and 2004. Chi-square and chi(2) trend tests, as well as multivariate logistic regression models, were used to assess the effect of age, gender, race, region of residence, and year of surgery on the rate of CNT. Adjustment was made for the size of the primary tumor. RESULTS: The overall rate of CNT was 30.5%. The rate of CNT increased in the most recent year quartile (P
