Jeldres Claudio, Baillargeon-Gagne Sara, Liberman Daniel, Isbarn Hendrik, Capitanio Umberto, Shariat Shahrokh F, Sun Maxine, Lughezzani Giovanni, Perrotte Paul, Montorsi Francesco, Graefen Markus, Karakiewicz Pierre I
Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebéc, Canada.
Urology. 2009 Oct;74(4):837-41. doi: 10.1016/j.urology.2009.04.019. Epub 2009 Jul 18.
To examine temporal, geographic, socioeconomic, and clinical determinants of cytoreductive nephrectomy (CNT) use in the surveillance, epidemiology, and end results (SEER) database, because CNT is known to improve survival in patients with metastatic renal cell carcinoma (mRCC).
Within the SEER database, we identified 6226 mRCC patients, who were either treated with CNT (n = 2038) or underwent no surgery (n = 4188) between 1989 and 2004. Chi-square and chi(2) trend tests, as well as multivariate logistic regression models, were used to assess the effect of age, gender, race, region of residence, and year of surgery on the rate of CNT. Adjustment was made for the size of the primary tumor.
The overall rate of CNT was 30.5%. The rate of CNT increased in the most recent year quartile (P <.001), was more frequent in white patients (P = .005), males (P = .001), and younger patients (P <.001). Moreover, CNT was more frequently performed for larger primary tumors (P <.001). Finally, important variability was found to exist in the rate of CNT between the 9 SEER registries (range 29.5%-38.6%, P = .002). In multivariate logistic regression models, age (P <.001), race (P <.001), year of surgery (P <.001), primary tumor size (P <.001), and SEER region (P = .003) were independent predictors of CNT rate.
Racial and geographic variability in CNT rates is worrisome and warrants further attention. In view of the survival benefits of CNT, its access should be equal for all races and regions.
在监测、流行病学和最终结果（SEER）数据库中研究减瘤性肾切除术（CNT）使用的时间、地理、社会经济和临床决定因素，因为已知CNT可提高转移性肾细胞癌（mRCC）患者的生存率。
在SEER数据库中，我们识别出6226例mRCC患者，他们在1989年至2004年间要么接受了CNT治疗（n = 2038），要么未接受手术（n = 4188）。采用卡方检验和卡方趋势检验以及多因素逻辑回归模型，评估年龄、性别、种族、居住地区和手术年份对CNT率的影响。对原发肿瘤大小进行了校正。
CNT的总体使用率为30.5%。CNT率在最近一年四分位数中有所上升（P <.001），在白人患者（P =.005）、男性（P =.001）和年轻患者（P <.001）中更常见。此外，对于较大的原发肿瘤，CNT更常进行（P <.001）。最后，发现9个SEER登记处之间的CNT率存在重要差异（范围为29.5% - 38.6%，P =.002）。在多因素逻辑回归模型中，年龄（P <.001）、种族（P <.001）、手术年份（P <.001）、原发肿瘤大小（P <.001）和SEER地区（P =.003）是CNT率的独立预测因素。
CNT率的种族和地理差异令人担忧，值得进一步关注。鉴于CNT对生存有益，所有种族和地区都应平等获得该治疗。
