Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, USA.
BJU Int. 2012 Oct;110(8):1156-61. doi: 10.1111/j.1464-410X.2012.10969.x. Epub 2012 Feb 28.
What's known on the subject? and What does the study add? Treatment options for small renal masses include radical nephrectomy (RN), partial nephrectomy (PN), ablation, and surveillance. PN provides equivalent oncological as RN for small tumours, but long-term outcomes for ablation and surveillance are poorly defined. Due to changing techniques and technology, treatment patterns for small renal masses are rapidly developing. Prior studies had analysed utilisation trends for PN and RN to 2006, revealing a relative rise in the rate of PN. However, overall treatment trends including surveillance and ablation had not been studied using a population-based cohort. It has become increasingly clear that RN is associated with greater renal and cardiovascular deterioration than nephron-sparing treatments. Thus, it is important to understand current population-based practice patterns for the treatment of small renal masses to assess whether practitioners are adhering to ever-changing principles in this field. The present study provides up-to-date treatment trends in the USA using a large population-based cohort.
To describe the changing practice patterns in the management of small renal masses, including the use of surveillance and ablative techniques.
All patients in the Surveillance, Epidemiology and End Results (SEER) registry treated for renal masses of ≤7 cm in diameter, from 1998 to 2008, were included for analysis. Annual trends in the use of surveillance, ablation, partial nephrectomy (PN), and radical nephrectomy (RN) were calculated. Multinomial logistic regression was used to determine the association of demographic and clinical characteristics with treatment method.
In all, 48 148 patients from 17 registry sites with a mean age of 63.4 years were included for analysis. Between 1998 and 2008, for masses of <2 cm and 2.1-4 cm, there was a dramatic increase in the proportion of patients undergoing PN (31% vs 50%, 16% vs 33%, respectively) and ablation (1% vs 11%, 2% vs 9%, respectively). In multivariable analysis, later year of diagnosis, male gender, being married, clinically localised disease, and smaller tumours were associated with increased use of PN vs RN. Later year of diagnosis, male gender, being unmarried, smaller tumour, and the presence of bilateral masses were associated with increased use of ablation and surveillance vs RN.
PN is now used in half of all patients with the smallest renal masses, and its use continues to increase over time. Ablation and surveillance are less common overall, but there is increased usage over time in select populations.
描述美国在治疗小肾肿瘤方面的管理实践模式的变化趋势，包括使用监测和消融技术。
所有在 1998 年至 2008 年间接受直径≤7cm 肾肿瘤治疗的监测、流行病学和最终结果（SEER）登记处患者均纳入分析。计算了监测、消融、部分肾切除术（PN）和根治性肾切除术（RN）的年度使用趋势。采用多项逻辑回归来确定人口统计学和临床特征与治疗方法的相关性。
共纳入了来自 17 个登记处的 48148 名平均年龄为 63.4 岁的患者。在 1998 年至 2008 年期间，对于<2cm 和 2.1-4cm 的肿瘤，接受 PN（31%对 50%，16%对 33%）和消融（1%对 11%，2%对 9%）治疗的患者比例大幅增加。在多变量分析中，诊断的后期年份、男性、已婚、临床局限性疾病和较小的肿瘤与 PN 与 RN 相比的使用率增加相关。诊断的后期年份、男性、未婚、较小的肿瘤以及双侧肿瘤的存在与消融和监测与 RN 相比的使用率增加相关。
PN 现在用于一半的最小肾肿瘤患者，其使用率随着时间的推移而持续增加。总体而言，消融和监测的使用率较低，但在某些人群中随着时间的推移使用率有所增加。
