Objectives:
The Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) was developed by the Australian Bureau of Statistics to allow quantitative comparisons between metropolitan and rural Australia. By applying the ASGC-RA to a cohort of patients undergoing surgery for RCC, we sought to determine whether patients from regional areas presented with more advanced stage disease than their metropolitan counterparts.

Methods:
221 patients undergoing surgery for RCC were identified retrospectively from Jan 2004 to June 2012. ASGC-RA scoring was based on location of residence at the time of surgery: metropolitan = RA1, inner regional = RA2 and outer regional = RA3. Patients were obtained from both a metropolitan tertiary referral centre (n = 146) and a large regional hospital (n = 75). Data collected included age, gender, clinical presentation, stage and final histopathology. Statistical significance was ascribed to p < 0.05 on Pearson’s Chi-square tests.

Results:
The mean age of patients from RA1, RA2 and RA3 was 59 years, 64 years and 56 years respectively. There was no significant difference between the groups with regard to age, sex or mode of presentation. Our metropolitan centre operated on 84 patients from RA1, 51 from RA2 and 11 from RA3. There was a significant association between increasing ASGC-RA and clinical T-stage (p = 0.043), with the proportion of T1 tumors falling from 63% of RA1 to 27% of RA3 patients. Conversely, the proportion of patients with T3+ disease rose from 30% of RA1 to 73% of RA3 patients (p = 0.016). The proportion of patients presenting with M1 disease rose from 11% of RA1 to 27% of RA3 patients (p = 0.05). Our large regional centre operated on a further 62 patients from RA2 and 13 patients from RA3, with RA3 again having more patients presenting with T3+ disease (31% vs 5%, p = 0.003). When all 221 patients were analysed as a group, clinical T stage was significantly associated with ASGC-RA (p < 0.001), symptomatic presentation (p < 0.001), N stage (p < 0.001), M stage (p < 0.001) and Fuhrman grade (p < 0.001).

Conclusion:
Renal cell carcinoma presents with more advanced stage disease in patients from regional areas compared to their metropolitan counterparts. Whilst determining the exact cause for this variation is beyond the scope of the present study, our findings nevertheless reinforce the inequality of access, and thus poorer health outcomes, experienced by regional Australians.