Cancer Prognostics and Health Outcomes Unit, Montreal, Quebec, Canada.
Int J Urol. 2014 Feb;21(2):122-8. doi: 10.1111/iju.12204. Epub 2013 Jul 2.
To examine utilization rates of partial nephrectomy relative to radical nephrectomy for T1b renal cell carcinoma in contemporary years, to identify sociodemographic and disease characteristics associated with partial nephrectomy use, and to compare effectiveness of partial versus radical nephrectomy with respect to cancer control.
Using the Surveillance, Epidemiology, and End Results database, 16,333 patients treated with partial or radical nephrectomy for T1bN0M0 renal cell carcinoma between 1988 and 2008 were identified. Logistic regression models were carried out to identify determinants of partial nephrectomy. Subsequently, cumulative incidence rates of cancer-specific and other-cause mortality between partial and radical nephrectomy were assessed, within the matched cohort. Furthermore, competing-risks regression analyses were used for prediction of cancer-specific mortality, after adjusting for other-cause mortality, and vice versa.
The utilization rate of partial nephrectomy increased from 1.2% in 1988 to 15.9% in 2008 (P < 0.001). Younger individuals, smaller tumors, persons of black race, as well as men, were more likely to be treated with partial nephrectomy in the current cohort (all P ≤ 0.002). In the post-propensity cohort, the 5- and 10-year cancer-specific mortality rates were 4.4 and 6.1% for partial versus 6.0 and 10.4% for radical nephrectomy, respectively (P = 0.03). Competing-risks regression analyses showed that nephrectomy type was not statistically significantly associated with cancer-specific mortality, even after adjusting for other-cause mortality (hazard ratio 0.89, P = 0.5).
Despite providing a comparable cancer control, the use of partial over radical nephrectomy for T1b renal cell carcinoma in USA has remained limited in recent years.
检查近年来 T1b 期肾细胞癌采用部分肾切除术与根治性肾切除术的比例，确定与部分肾切除术应用相关的社会人口学和疾病特征，并比较部分肾切除术与根治性肾切除术在癌症控制方面的效果。
利用监测、流行病学和最终结果数据库，确定了 1988 年至 2008 年间 16333 例 T1bN0M0 期肾细胞癌患者接受部分或根治性肾切除术的治疗情况。采用逻辑回归模型确定部分肾切除术的决定因素。随后，在匹配队列中评估部分和根治性肾切除术后癌症特异性和其他原因死亡率的累积发生率。此外，在调整其他原因死亡率后，使用竞争风险回归分析预测癌症特异性死亡率，反之亦然。
部分肾切除术的使用率从 1988 年的 1.2%增加到 2008 年的 15.9%（P<0.001）。在当前队列中，年龄较小、肿瘤较小、黑人以及男性患者更有可能接受部分肾切除术治疗（所有 P≤0.002）。在倾向后队列中，5 年和 10 年的癌症特异性死亡率分别为部分肾切除术 4.4%和 6.1%，根治性肾切除术为 6.0%和 10.4%（P=0.03）。竞争风险回归分析显示，即使在调整其他原因死亡率后，手术类型与癌症特异性死亡率无统计学显著相关性（风险比 0.89，P=0.5）。
尽管部分肾切除术在癌症控制方面具有可比性，但近年来美国 T1b 期肾细胞癌采用部分肾切除术而非根治性肾切除术的比例仍然有限。
