Zini Laurent, Perrotte Paul, Capitanio Umberto, Jeldres Claudio, Duclos Alain, Arjane Philippe, Villers Arnauld, Montorsi Francesco, Patard Jean-Jacques, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montréal, Québec, Canada.
BJU Int. 2009 Apr;103(7):889-93. doi: 10.1111/j.1464-410X.2008.08119.x. Epub 2008 Nov 18.
To assess whether, in contemporary patients with renal cell carcinoma (RCC), access to nephrectomy is the same between the Blacks and Whites, and that there is no difference in mortality after stratification for treatment type.
The effect of race has received little attention in RCC; only two reports have addressed and suggested the presence of racial disparities, including access to nephrectomy and survival after nephrectomy, where Black patients were disadvantaged relative to Whites. We used the Surveillance, Epidemiology and End Results data from 12 516 patients of all stages diagnosed and treated for RCC between 2000 and 2004. The effect of race (Black vs White) on nephrectomy rate was addressed in logistic regression and binomial regression models, and Cox regression models tested the effect of race on overall survival.
Black patients were 50% less likely to have a nephrectomy than their White counterparts. However, race had no effect on overall survival when the entire cohort was assessed, as well as in subgroups of patients with or without nephrectomy.
Although race is a determinant of access to nephrectomy, it should not be interpreted as a barrier to care, as survival was unaffected by race in patients having a nephrectomy or not. Instead, race might represent a proxy of comorbidity and life-expectancy, which represent surgical selection criteria for nephrectomy.
评估在当代肾细胞癌（RCC）患者中，黑人和白人接受肾切除术的情况是否相同，以及在按治疗类型分层后死亡率是否存在差异。
种族对肾细胞癌的影响鲜受关注；仅有两份报告探讨并提示存在种族差异，包括接受肾切除术的情况以及肾切除术后的生存率，其中黑人患者相对于白人处于劣势。我们使用了监测、流行病学和最终结果数据，这些数据来自2000年至2004年间诊断和治疗的12516例各阶段肾细胞癌患者。在逻辑回归和二项式回归模型中分析种族（黑人与白人）对肾切除率的影响，Cox回归模型检验种族对总生存率的影响。
黑人患者接受肾切除术的可能性比白人患者低50%。然而，在评估整个队列以及接受或未接受肾切除术的患者亚组时，种族对总生存率均无影响。
尽管种族是接受肾切除术的一个决定因素，但不应将其视为获得治疗的障碍，因为无论患者是否接受肾切除术，生存率均不受种族影响。相反，种族可能代表了合并症和预期寿命，而这是肾切除术的手术选择标准。
