Zini Laurent, Capitanio Umberto, Perrotte Paul, Jeldres Claudio, Shariat Shahrokh F, Arjane Philippe, Widmer Hugues, Montorsi Francesco, Patard Jean-Jacques, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Urology. 2009 Feb;73(2):342-6. doi: 10.1016/j.urology.2008.09.022. Epub 2008 Nov 28.
To examine the population-based survival rates of patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CNT) and compare them with those of patients treated without surgery.
Of the 43,143 patients with RCC identified in the 1988-2004 Surveillance, Epidemiology, and End Results database, 5372 had metastatic RCC. Of those, 2447 were treated with CNT (45.5%) and 2925 (54.5%) were not. Univariable and multivariable Cox regression models, as well as matched and unmatched Kaplan-Meier survival analyses, were used. The covariates consisted of age, sex, tumor size, and year of diagnosis.
The 1-, 2-, 5-, and 10-year overall survival rate of the patients treated with CNT was 53.6%, 36.3%, 19.4%, and 12.7% compared with 18.5%, 7.4%, 2.3%, and 1.2% for the no-surgery patients, respectively. The corresponding cancer-specific survival rates were 58.1%, 40.8%, 24.3%, and 18.8% and 24.4%, 11.0%, 4.1%, and 2.9% for the same patient groups. On multivariate analysis, independent predictor status was recorded for treatment type, tumor size, and patient age (all P <.001). Also, relative to CNT, the no-surgery group had a 2.5-fold greater rate of overall and cancer-specific mortality (P <.001). In the matched analyses, virtually the same effect was recorded (hazard ratio 2.6, P <.001).
The results of our study have shown that CNT significantly improves the survival of patients with metastatic RCC.
研究接受减瘤性肾切除术（CNT）治疗的转移性肾细胞癌（RCC）患者的人群生存率，并与未接受手术治疗的患者进行比较。
在1988 - 2004年监测、流行病学和最终结果数据库中识别出的43143例RCC患者中，5372例患有转移性RCC。其中，2447例接受了CNT治疗（45.5%），2925例（54.5%）未接受治疗。使用单变量和多变量Cox回归模型以及匹配和未匹配的Kaplan-Meier生存分析。协变量包括年龄、性别、肿瘤大小和诊断年份。
接受CNT治疗的患者1年、2年、5年和10年总生存率分别为53.6%、36.3%、19.4%和12.7%，而未接受手术治疗的患者分别为18.5%、7.4%、2.3%和1.2%。相同患者组的相应癌症特异性生存率分别为58.1%、40.8%、24.3%和18.8%以及24.4%、11.0%、4.1%和2.9%。多变量分析显示，治疗类型、肿瘤大小和患者年龄均为独立预测因素（均P <.001）。此外，与CNT组相比，未接受手术治疗组的总死亡率和癌症特异性死亡率高出2.5倍（P <.001）。在匹配分析中，记录到几乎相同的结果（风险比2.6，P <.001）。
我们的研究结果表明，CNT可显著提高转移性RCC患者的生存率。
