Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
BJU Int. 2013 Jun;111(8):E283-9. doi: 10.1111/bju.12115.
To examine the impact of length of survival on future survival probability, otherwise known as the effect of conditional survival (CS), after nephrectomy (NT) in patients diagnosed with renal cell carcinoma (RCC).
Overall, 42,090 patients with RCC who underwent NT were abstracted from the Surveillance, Epidemiology, and End Results database (1988-2008). Based on cumulative survival estimates, CS rates were derived according to patient and disease characteristics. Separate multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality (CSM), according to 1-, 2-, 3-, 4- and 5-year survival postoperatively.
Immediately after surgery, the 5-year cancer-specific survival rate was 83.5%. Amongst patients who survived ≥1, ≥2, ≥3, ≥4, and ≥5 years after NT, the probability rates for surviving an additional 5 years were 87.0, 89.6, 90.9, 92.0 and 92.3%, respectively. Provided that patients survived 1 and 2 years after NT, the probability of being CSM-free for another 5 years increased by +4.1 and 4.3% for stage III and +12.9 and 10.3% for stage IV disease, respectively. Similar observations were recorded for patient age, grade, nodal stage and tumour size, and were confirmed upon multivariable analyses.
Survival probabilities vary according to length of survival after NT. Specifically, even amongst patients with more advanced disease at surgery, a more favourable prognosis can be achieved after surviving for 1-2 years.
研究肾细胞癌（RCC）患者肾切除术后（NT）生存时间对未来生存概率（又称条件生存（CS）的影响。
从监测、流行病学和最终结果数据库（1988-2008 年）中提取了 42090 例接受 NT 的 RCC 患者的总体资料。根据累积生存估计，根据患者和疾病特征得出 CS 率。根据术后 1、2、3、4 和 5 年的生存情况，分别对癌症特异性死亡率（CSM）的预测进行了多变量 Cox 回归分析。
术后 5 年癌症特异性生存率为 83.5%。在 NT 后存活≥1、≥2、≥3、≥4 和≥5 年的患者中，额外存活 5 年的概率分别为 87.0%、89.6%、90.9%、92.0%和 92.3%。假设患者在 NT 后存活 1 年和 2 年，那么 III 期和 IV 期疾病的 CSM 无风险的概率分别增加了+4.1%和+4.3%，以及+12.9%和+10.3%。对患者年龄、分级、淋巴结分期和肿瘤大小也进行了类似的观察，并在多变量分析中得到了证实。
NT 后生存时间的长短会影响生存概率。具体来说，即使在手术时疾病更严重的患者中，在存活 1-2 年后也能获得更有利的预后。
