Department of Urology, Georgetown University Hospital, Washington, DC.
J Urol. 2013 Nov;190(5):1680-5. doi: 10.1016/j.juro.2013.05.109. Epub 2013 Jun 11.
With the increasing incidence of small renal masses, there is greater use of ablation, nephron sparing surgery and surveillance compared to radical nephrectomy. However, patterns of care in the use of posttreatment imaging remain uncharacterized. The purpose of this study is to determine the rate of posttreatment imaging after various treatments for small renal mass.
Using SEER (Surveillance, Epidemiology and End Results)-Medicare data during 2005 to 2009, we identified 1,682 subjects diagnosed with small renal mass and treated with open partial nephrectomy (330), minimally invasive partial nephrectomy (160), open radical nephrectomy (404), minimally invasive radical nephrectomy (535), thermal ablation (212) and surveillance (42). Use of imaging was compared within 24 months of treatment and multivariate regression models were constructed to identify factors associated with increased imaging use.
On adjusted analyses thermal ablation was associated with almost eightfold greater odds of surveillance imaging compared with open radical nephrectomy (OR 7.7, 95% CI 1.01-59.4). Specifically, thermal ablation was associated with increased computerized tomography (OR 5.28) and magnetic resonance imaging (OR 2.19) use and decreased ultrasound use (OR 0.59). Minimally invasive partial nephrectomy (OR 3.28) and open partial nephrectomy (OR 3.19) were also associated with increased computerized tomography use to a lesser extent.
Subjects undergoing nephron sparing surgery undergo more posttreatment imaging compared to open radical nephrectomy. Although possibly associated with lower morbidity, thermal ablation is associated with significantly greater use of imaging compared to other small renal mass treatments. This may increase costs and radiation exposure, although further study is needed for confirmation.
随着小肾肿瘤发病率的增加，与根治性肾切除术相比，消融术、保肾手术和监测的应用越来越多。然而，治疗后影像学的应用模式仍不明确。本研究旨在确定小肾肿瘤不同治疗方法后进行治疗后影像学检查的比例。
使用 2005 年至 2009 年 SEER（监测、流行病学和最终结果）-医疗保险数据，我们确定了 1682 名接受开放部分肾切除术（330 例）、微创部分肾切除术（160 例）、开放根治性肾切除术（404 例）、微创根治性肾切除术（535 例）、热消融术（212 例）和监测（42 例）治疗的小肾肿瘤患者。比较了治疗后 24 个月内的影像学使用情况，并构建了多变量回归模型，以确定与增加影像学使用相关的因素。
在调整后的分析中，与开放根治性肾切除术相比，热消融术与监测成像的相关性几乎增加了 8 倍（OR7.7，95%CI1.01-59.4）。具体来说，热消融术与增加计算机断层扫描（OR5.28）和磁共振成像（OR2.19）的使用以及减少超声检查的使用（OR0.59）相关。微创部分肾切除术（OR3.28）和开放部分肾切除术（OR3.19）也与计算机断层扫描使用的增加有一定相关性。
保肾手术患者比开放根治性肾切除术患者进行更多的治疗后影像学检查。尽管可能与较低的发病率相关，但与其他小肾肿瘤治疗方法相比，热消融术与影像学检查的使用显著增加相关。这可能会增加成本和辐射暴露，尽管还需要进一步的研究来证实。
