Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
BJU Int. 2010 Feb;105(3):359-64. doi: 10.1111/j.1464-410X.2009.08745.x.
Prevalence (prospective cohort with good follow up).
1a.
To examine contemporary (1989-2004) trends in partial nephrectomy (PN) within the Surveillance, Epidemiology and End Results (SEER) database, as among other considerations, a survival benefit due to avoidance of surgically induced renal insufficiency distinguishes PN from radical nephrectomy (RN).
Diagnostic, stage and surgical codes of patients with T1-2N0M0 renal cell carcinoma treated with either PN or RN were assessed. Proportions, trends and multivariable logistic regression models tested the predictors of the use of PN.
Of 19 733 assessable patients, 2614 (13.2%) and 17 119 (86.8%), respectively, had PN or RN. The use of PN decreased with increasing tumour size, was more frequent in younger patients and increased with more contemporary years of surgery (all P < 0.001). Intriguingly, there was important geographical variability (P < 0.001), e.g. in the San Francisco-Oakland Metropolitan Area the absolute PN rate was 16.4%, vs 7.6% in New Mexico (P < 0.001). In multivariable analyses, tumour size, age, year of surgery, gender and SEER registries were independent predictors of PN use.
Although as expected the rate of PN use increased over time, unexplained variability remained. For example, gender and SEER registries affected the likelihood of PN. These variables warrant further analyses to reduce unnecessary variability and to maximize PN use and its benefit.
患病率（前瞻性队列研究，随访良好）。
1a。
在监测、流行病学和最终结果（SEER）数据库中检查 1989 年至 2004 年部分肾切除术（PN）的当代趋势，因为与根治性肾切除术（RN）相比，PN 由于避免手术引起的肾功能不全而具有生存优势。
评估接受 PN 或 RN 治疗的 T1-2N0M0 肾细胞癌患者的诊断、分期和手术代码。比例、趋势和多变量逻辑回归模型检验了使用 PN 的预测因素。
在 19733 例可评估患者中，分别有 2614 例（13.2%）和 17119 例（86.8%）接受了 PN 或 RN。随着肿瘤大小的增加，PN 的使用比例降低，在年轻患者中更为常见，并且随着手术时间的推移而增加（均 P < 0.001）。有趣的是，存在重要的地域差异（P < 0.001），例如在旧金山-奥克兰大都市区，绝对 PN 率为 16.4%，而在新墨西哥州为 7.6%（P < 0.001）。在多变量分析中，肿瘤大小、年龄、手术年份、性别和 SEER 登记处是 PN 使用的独立预测因素。
尽管 PN 使用的比例随着时间的推移而增加，但仍存在无法解释的差异。例如，性别和 SEER 登记处影响 PN 的可能性。这些变量需要进一步分析，以减少不必要的差异，并最大限度地提高 PN 的使用及其益处。
