Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, University of California-San Francisco Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California 94143-1695, USA.
J Urol. 2011 Aug;186(2):394-9. doi: 10.1016/j.juro.2011.03.130. Epub 2011 Jun 15.
Renal cell carcinoma is increasingly diagnosed at stage I, and among stage I cases mean tumor size has been decreasing. Previous reports suggest that nephron sparing surgery is underused for small renal cell carcinomas. We determined updated, population based treatment trends for stage I renal cell carcinoma.
The National Cancer Data Base, which captures approximately 70% of all cancer diagnoses in the United States, was queried for renal cell carcinoma in adults diagnosed between 1993 and 2007. Trends in treatment, including no surgery, total nephrectomy, partial nephrectomy and focal ablation, were analyzed among all stage I tumors and small stage I tumors categorized by size. Logistic regression was used to identify predictors of nephron sparing surgery (partial nephrectomy or focal ablation).
During the study period we identified 242,740 renal cell carcinomas, of which 127,691 were stage I. For all stage I tumors partial nephrectomy increased from 6.3% to 32.2% of cases and ablation increased from 1.0% to 6.8%. For tumors less than 2.0, 2.0 to 2.9 and 3.0 to 3.9 cm partial nephrectomy increased from 15.3% to 61.1%, 11.0% to 44.2% and 7.2% to 31.1%, respectively (each p<0.001). Female gender, black race, Hispanic ethnicity, lower income, older age and treatment at community hospitals were associated with lower use of nephron sparing.
While total nephrectomy is still likely overused for small renal cell carcinoma, nephron sparing surgery for stage I renal cell carcinoma has increased substantially in the last 15 years with about 4-fold increases across tumor sizes. These trends appear to be ongoing but sociodemographic disparities exist which must be rectified.
肾细胞癌的诊断分期越来越多地处于 I 期，且 I 期病例的肿瘤平均大小呈下降趋势。既往报道提示小体积肾细胞癌行保留肾单位手术（nephron sparing surgery）的比例不足。本研究旨在明确 I 期肾细胞癌的治疗趋势。
国家癌症数据库（National Cancer Data Base）纳入了美国约 70%的癌症病例，我们对该数据库中 1993 年至 2007 年间诊断为肾细胞癌的成人病例进行了检索，分析了所有 I 期肿瘤和小体积 I 期肿瘤（根据肿瘤大小分类）的治疗趋势，包括无手术、根治性肾切除术、部分肾切除术和局部消融术。采用 logistic 回归分析了影响保留肾单位手术（部分肾切除术或局部消融术）的预测因素。
研究期间共发现 242740 例肾细胞癌，其中 I 期 127691 例。所有 I 期肿瘤中，部分肾切除术的比例从 6.3%增加到 32.2%，局部消融术从 1.0%增加到 6.8%。肿瘤体积<2.0、2.02.9 和 3.03.9 cm 时，部分肾切除术的比例分别从 15.3%增加到 61.1%、11.0%增加到 44.2%、7.2%增加到 31.1%（均 p<0.001）。女性、黑人、西班牙裔、低收入、高龄以及在社区医院治疗与保留肾单位手术的应用减少相关。
尽管小体积肾细胞癌根治性肾切除术仍可能过度应用，但过去 15 年中 I 期肾细胞癌保留肾单位手术的应用显著增加，各肿瘤体积的手术比例增加了约 4 倍。这些趋势仍在继续，但社会人口统计学差异依然存在，亟待纠正。
