Division of Urology, University of California San Diego School of Medicine, La Jolla, CA 92093-0987, USA.
BJU Int. 2013 Jun;111(8):1261-8. doi: 10.1111/j.1464-410X.2012.11497.x. Epub 2013 Mar 7.
To evaluate the diffusion of nephron-sparing modalities (NSM) for the treatment of renal neoplasms in the USA over the last decade and to identify the factors associated with renal procedure selection.
The Nationwide Inpatient Sample was utlized to identify patients undergoing cryo/radiofrequency ablation (C/RFA), radical nephrectomy (RN) and partial nephrectomy (PN) from 1998 to 2008. Annual trends in procedure prevalence were determined. Multivariate analyses were performed to query the influence of age, race, sex and comorbid disease on surgery selection.
We identified 443,853 procedures performed during the study period: 25,599 C/RFA, 79,568 PN and 338,687 RN. The prevalence per 100,000 hospital admissions in 1998 was 3.7 for C/RFA, nine for PN and 87.1 for RN. All procedures increased over the study period, by 1.05, 3.1 and 2.2/100,000 admissions per year, respectively (all P < 0.001). Diabetes, urban, teaching and large capacity hospitals were associated with NSM (either C/RFA or PN) compared to RN (all P ≤ 0.011). Age ≥70 years, female, hypertension, diabetes, chronic kidney disease (CKD) and region outside the Northeast favoured C/RFA over PN (all P ≤ 0.026). Compared to those without CKD, patients with CKD had an almost twofold higher probability of undergoing RN than NSM (odds ratio, 1.88; 95% confidence interval, 1.7-2.1). Despite increasing NSM utilization over the study period, most patients with CKD still received RN.
Although the prevalence of NSM is increasing, RN is more common. The low utilization of NSM in patients with pre-existing CKD warrants further investigation.
评估过去十年美国保肾治疗肾肿瘤的保肾术式（NSM）的扩散情况，并确定与肾脏手术选择相关的因素。
利用全国住院患者样本，于 1998 年至 2008 年间，确定接受冷冻/射频消融术（C/RFA）、根治性肾切除术（RN）和部分肾切除术（PN）的患者。确定了手术流行率的年度趋势。进行了多变量分析，以探究年龄、种族、性别和合并症对手术选择的影响。
我们在研究期间共确定了 443853 例手术：25599 例 C/RFA、79568 例 PN 和 338687 例 RN。1998 年，每 100000 例住院患者的流行率分别为 C/RFA 的 3.7、PN 的 9 和 RN 的 87.1。所有手术在研究期间均有所增加，每年分别增加 1.05、3.1 和 2.2/100000 例住院患者（均 P<0.001）。与 RN 相比，糖尿病、城市、教学和大容量医院与 NSM（无论是 C/RFA 还是 PN）相关（均 P≤0.011）。年龄≥70 岁、女性、高血压、糖尿病、慢性肾脏病（CKD）和东北部以外地区更倾向于选择 C/RFA 而不是 PN（均 P≤0.026）。与没有 CKD 的患者相比，有 CKD 的患者接受 RN 的可能性几乎是 NSM 的两倍（比值比，1.88；95%置信区间，1.7-2.1）。尽管 NSM 的应用率在研究期间有所增加，但大多数 CKD 患者仍接受 RN。
尽管 NSM 的流行率在增加，但 RN 更为常见。在存在 CKD 的患者中，NSM 的应用率较低，需要进一步调查。
