Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2010 Feb;183(2):467-72. doi: 10.1016/j.juro.2009.10.002. Epub 2009 Dec 14.
Recent evidence suggests that partial nephrectomy may be associated with improved survival compared to radical nephrectomy for renal cell carcinoma but partial nephrectomy may be underused. We examined whether the introduction of laparoscopic radical nephrectomy contributed to low partial nephrectomy use with time.
We identified all patients treated surgically for renal cell carcinoma in Ontario, Canada between 1995 and 2004 using the Ontario Cancer Registry, a population based tumor registry. A multinomial logistic regression model was used to relate the relative numbers of patients with open and laparoscopic radical nephrectomy, and partial nephrectomy to patient age, gender and surgery year. The partial nephrectomy time trend was investigated by fitting a segmented regression model.
Of 7,830 surgically treated patients 7,042 (89.9%) vs 788 (10.1%) underwent radical vs partial nephrectomy. Segmented regression showed a clear change in partial nephrectomy use with time (p = 0.001), such that the odds of partial nephrectomy increased by 18% per year before January 2003 (OR 1.18, 95% CI 1.14-1.23) and subsequently decreased by 12% per year (OR 0.88, 95% CI 0.75-1.02). In the multinomial regression model age and surgery year but not gender were independently associated with partial nephrectomy.
Partial nephrectomy use for renal cell carcinoma remains low, particularly in elderly patients. The introduction of laparoscopic radical nephrectomy coincided with decreased uptake and use of partial nephrectomy for renal cell carcinoma. Although it was hypothesized previously, to our knowledge this is the first study to suggest that the introduction of laparoscopy in renal surgery has negatively impacted partial nephrectomy use.
最近的证据表明，与根治性肾切除术相比，部分肾切除术可能与改善肾细胞癌患者的生存相关，但部分肾切除术的应用可能不足。我们研究了腹腔镜根治性肾切除术的引入是否随着时间的推移导致部分肾切除术的使用率降低。
我们利用安大略省癌症登记处（一个基于人群的肿瘤登记处），在加拿大安大略省识别了 1995 年至 2004 年间接受手术治疗的所有肾细胞癌患者。我们使用多项逻辑回归模型，将接受开放性和腹腔镜根治性肾切除术以及部分肾切除术的患者数量与患者年龄、性别和手术年份相关联。通过拟合分段回归模型来研究部分肾切除术的时间趋势。
在接受手术治疗的 7830 例患者中，7042 例（89.9%）接受了根治性肾切除术，788 例（10.1%）接受了部分肾切除术。分段回归显示部分肾切除术的使用率随时间明显变化（p=0.001），在 2003 年 1 月之前，部分肾切除术的比例每年增加 18%（OR 1.18，95%CI 1.14-1.23），随后每年减少 12%（OR 0.88，95%CI 0.75-1.02）。在多项逻辑回归模型中，年龄和手术年份，但不是性别，与部分肾切除术独立相关。
肾细胞癌的部分肾切除术使用率仍然较低，特别是在老年患者中。腹腔镜根治性肾切除术的引入与肾细胞癌部分肾切除术的应用减少有关。尽管之前有假设，但据我们所知，这是第一项表明腹腔镜在肾脏手术中的应用对部分肾切除术使用率产生负面影响的研究。
