Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Department of Urology, University of Montreal, Montreal, Québec, Canada.
Eur Urol. 2009 Dec;56(6):998-1003. doi: 10.1016/j.eururo.2008.11.023. Epub 2008 Nov 25.
The existing literature suggests that the surgical mortality (SM) observed with nephrectomy for localised disease varies from 0.6% to 3.6%.
To examine age- and stage-specific 30-d mortality (TDM) rates after partial or radical nephrectomy.
DESIGN, SETTING, AND PARTICIPANTS: We relied on 24535 assessable patients from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database.
In 12283 patients, logistic regression models were used to develop a tool for pretreatment prediction of the probability of TDM according to individual patient and tumour characteristics. External validation was performed on 12252 patients.
In the entire cohort of 24535 patients, 219 deaths occurred during the initial 30 d after nephrectomy (0.9% TDM rate). TDM increased with age (≤49 yr: 0.5% vs 50-59 yr: 0.7% vs 60-69 yr: 0.9% vs 70-79 yr: 1.2% vs ≥80 yr: 2.0%; χ(2) trend p<0.001) and stage (0.3% for T1-2N0M0 vs 1.3% for T3-4N0-2M0 vs 4.2% for T1-4N0-2M1; χ2 trend p=<0.001). TDM decreased in more recent years (1988-1993: 1.3% vs 1994-1998: 0.9% vs 1999-2002: 0.7% vs 2003-2004: 0.6%; χ2 trend p<0.001) and was lower after partial versus radical nephrectomy (RN) (0.4% vs 0.9%; p=0.008). Only age (p<0.001) and stage (p<0.001) achieved independent predictor status. The look-up table that relied on the regression coefficients of age and stage reached 79.4% accuracy in the external validation cohort.
Age and stage are the foremost determinants of TDM after nephrectomy. Our model provides individual probabilities of TDM after nephrectomy, and its use should be highly encouraged during informed consent prior to planned nephrectomy.
现有文献表明，局限性疾病肾切除术的手术死亡率（SM）为 0.6%至 3.6%。
检查部分或根治性肾切除术后 30 天死亡率（TDM）的年龄和分期特异性。
设计、地点和参与者：我们依赖于国家癌症研究所（NCI）监测、流行病学和最终结果（SEER）数据库中的 24535 名可评估患者。
在 12283 名患者中，使用逻辑回归模型建立了一种工具，根据患者个体和肿瘤特征，在术前预测 TDM 的概率。对 12252 名患者进行了外部验证。
在整个 24535 名患者队列中，219 例患者在肾切除术后 30 天内死亡（0.9%TDM 率）。TDM 随年龄增加而增加（≤49 岁：0.5%vs50-59 岁：0.7%vs60-69 岁：0.9%vs70-79 岁：1.2%vs≥80 岁：2.0%；χ2趋势 p<0.001）和分期（T1-2N0M0 为 0.3%，T3-4N0-2M0 为 1.3%，T1-4N0-2M1 为 4.2%；χ2趋势 p<0.001）。近年来，TDM 有所下降（1988-1993 年：1.3%vs1994-1998 年：0.9%vs1999-2002 年：0.7%vs2003-2004 年：0.6%；χ2趋势 p<0.001），部分肾切除术（PN）与根治性肾切除术（RN）相比，TDM 发生率更低（0.4%vs0.9%；p=0.008）。只有年龄（p<0.001）和分期（p<0.001）达到独立预测因子地位。依赖于年龄和分期回归系数的查找表在外部验证队列中达到 79.4%的准确性。
年龄和分期是肾切除术后 TDM 的首要决定因素。我们的模型提供了肾切除术后 TDM 的个体概率，在计划肾切除术前知情同意过程中，应高度鼓励使用该模型。
