{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:31:57Z","timestamp":1765827117459,"version":"build-2065373602"},"reference-count":42,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2014,2,19]],"date-time":"2014-02-19T00:00:00Z","timestamp":1392768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2014,3]]},"abstract":"\n Objective<\/jats:title>\n To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation.<\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma (\n RCC<\/jats:styled-content>\n ) from\n J<\/jats:styled-content>\n anuary 2004 to\n J<\/jats:styled-content>\n une 2012, from both a metropolitan centre and a large inner regional hospital.\n <\/jats:p>\n Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features.<\/jats:p>\n \n The\n A<\/jats:styled-content>\n ustralian\n S<\/jats:styled-content>\n tandard\n G<\/jats:styled-content>\n eographical\n C<\/jats:styled-content>\n lassification\u2010\n R<\/jats:styled-content>\n emoteness\n A<\/jats:styled-content>\n rea (\n ASGC\u2010RA<\/jats:styled-content>\n ) is a system developed to allow quantitative comparisons between metropolitan and rural\n A<\/jats:styled-content>\n ustralia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan,\n RA<\/jats:styled-content>\n 1; inner regional,\n RA<\/jats:styled-content>\n 2; outer regional,\n RA<\/jats:styled-content>\n 3.\n <\/jats:p>\n \n Statistical significance was specified as\n P<\/jats:italic>\n < 0.05 on\n P<\/jats:styled-content>\n earson's chi\u2010square tests.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients in each\n ASGC\u2010RA<\/jats:styled-content>\n group did not differ significantly in age, sex or mode of presentation.\n <\/jats:p>\n \n Pathological\n T<\/jats:styled-content>\n stage on presentation increased with increasing\n ASGC\u2010RA<\/jats:styled-content>\n and thus distance from tertiary centres (\n P<\/jats:italic>\n = 0.004).\n <\/jats:p>\n \n The proportion of patients with\u2009\u2265\n T<\/jats:styled-content>\n 3 disease rose from 30% of\n RA<\/jats:styled-content>\n 1 to 73% of\n RA<\/jats:styled-content>\n 3 patients (\n P<\/jats:italic>\n = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with\u2009\u2265\n T<\/jats:styled-content>\n 3 disease from\n RA<\/jats:styled-content>\n 3 (31% vs 5%,\n P<\/jats:italic>\n = 0.003).\n <\/jats:p>\n \n When the 221 patients with\n RCC<\/jats:styled-content>\n were analysed as a group, clinical\n T<\/jats:styled-content>\n stage was significantly associated with\n ASGC\u2010RA<\/jats:styled-content>\n (\n P<\/jats:italic>\n < 0.001), symptomatic presentation (\n P<\/jats:italic>\n < 0.001),\n N<\/jats:styled-content>\n stage (\n P<\/jats:italic>\n < 0.001),\n M<\/jats:styled-content>\n stage (\n P<\/jats:italic>\n < 0.001) and\n F<\/jats:styled-content>\n uhrman grade (\n P<\/jats:italic>\n < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Our data quantifies the detrimental effect of physical distance on the health outcomes of regional\n A<\/jats:styled-content>\n ustralians with kidney cancer.\n <\/jats:p>\n Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.12459","type":"journal-article","created":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T10:00:26Z","timestamp":1378893626000},"page":"57-63","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The dilemma of distance: patients with kidney cancer from regional\n A<\/scp>\n ustralia present at a more advanced stage"],"prefix":"10.1111","volume":"113","author":[{"given":"Prassannah","family":"Satasivam","sequence":"first","affiliation":[{"name":"Department of Urology St Vincent's Hospital Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Department of Urology St Vincent's Hospital Melbourne 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