Cancer Prognostics and Health Outcomes Unit, Vita Salute San Raffaele University, Milan, Italy; Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
Int J Urol. 2013 Nov;20(11):1064-71. doi: 10.1111/iju.12110. Epub 2013 Feb 19.
To examine the trends of open and laparoscopic partial nephrectomy and radical nephrectomy according to sociodemographic and tumor characteristics.
Using the Surveillance, Epidemiology, and End Results Medicare-linked database, 6024 patients diagnosed with T1a renal cell carcinoma were abstracted. Multivariable logistic regression analyses were used for prediction of open radical nephrectomy, open partial nephrectomy, laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. Covariates comprised of patient age, baseline comorbidity status, sex, race, marital status, socioeconomic status, population density, Surveillance, Epidemiology and End Results registry, tumor size, and year of diagnosis.
Open radical nephrectomy decreased from 89% in 1988 to 66% in 2005 (P < 0.001), whereas open partial nephrectomy increased from 7% to 29% (P < 0.001). Meanwhile, utilization of either laparoscopic radical nephrectomy or laparoscopic partial nephrectomy remained low. Treatment utilization differed according to Surveillance, Epidemiology, and End Results registries (P < 0.001). Increasing patient age, female sex, low socioeconomic status and unmarried status (all P ≤ 0.003) were predictors of open radical nephrectomy. The utilization rates of laparoscopic radical nephrectomy or laparoscopic partial nephrectomy varied minimally according to the examined characteristics. Older patients or women were significantly more likely to undergo laparoscopic radical nephrectomy, even after adjustment for all covariates (both P ≤ 0.02).
The rising utilization rates of radical nephrectomy are encouraging. Nevertheless, disparities of treatment type still exist. It is of concern that older and female patients are less likely to undergo nephron-sparing surgery, and to have a radical nephrectomy by the laparoscopic approach instead.
根据社会人口统计学和肿瘤特征研究开放和腹腔镜部分肾切除术及根治性肾切除术的趋势。
利用监测、流行病学和最终结果医疗保险链接数据库，提取了 6024 例 T1a 肾细胞癌患者的资料。采用多变量逻辑回归分析预测开放根治性肾切除术、开放部分肾切除术、腹腔镜根治性肾切除术和腹腔镜部分肾切除术。协变量包括患者年龄、基线合并症状况、性别、种族、婚姻状况、社会经济状况、人口密度、监测、流行病学和最终结果登记处、肿瘤大小和诊断年份。
开放根治性肾切除术从 1988 年的 89%下降到 2005 年的 66%（P<0.001），而开放部分肾切除术从 7%增加到 29%（P<0.001）。与此同时，腹腔镜根治性肾切除术或腹腔镜部分肾切除术的应用仍然很低。治疗的应用因监测、流行病学和最终结果登记处而异（P<0.001）。患者年龄增加（P≤0.003）、女性、社会经济地位较低和未婚（均 P≤0.003）是开放根治性肾切除术的预测因素。腹腔镜根治性肾切除术或腹腔镜部分肾切除术的使用率根据所检查的特征变化很小。即使在调整了所有协变量后（均 P≤0.02），年龄较大的患者或女性接受腹腔镜根治性肾切除术的可能性显著增加。
根治性肾切除术使用率的上升令人鼓舞。然而，治疗方式的差异仍然存在。令人担忧的是，老年和女性患者接受保肾手术的可能性较小，而通过腹腔镜进行根治性肾切除术的可能性较小。
