Department of Urology, St Vincent's Hospital, Melbourne, Australia.
BJU Int. 2014 Mar;113 Suppl 2:57-63. doi: 10.1111/bju.12459.
To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation.
Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma (RCC) from January 2004 to June 2012, from both a metropolitan centre and a large inner regional hospital. Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features. The Australian Standard Geographical Classification-Remoteness Area (ASGC-RA) is a system developed to allow quantitative comparisons between metropolitan and rural Australia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan, RA1; inner regional, RA2; outer regional, RA3. Statistical significance was specified as P < 0.05 on Pearson's chi-square tests.
Patients in each ASGC-RA group did not differ significantly in age, sex or mode of presentation. Pathological T stage on presentation increased with increasing ASGC-RA and thus distance from tertiary centres (P = 0.004). The proportion of patients with ≥T3 disease rose from 30% of RA1 to 73% of RA3 patients (P = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with ≥T3 disease from RA3 (31% vs 5%, P = 0.003). When the 221 patients with RCC were analysed as a group, clinical T stage was significantly associated with ASGC-RA (P < 0.001), symptomatic presentation (P < 0.001), N stage (P < 0.001), M stage (P < 0.001) and Fuhrman grade (P < 0.001).
Our data quantifies the detrimental effect of physical distance on the health outcomes of regional Australians with kidney cancer. Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.
确定来自区域地区的接受肾癌手术的患者是否由于地理位置的隔离而表现出更晚期的疾病。
对 2004 年 1 月至 2012 年 6 月期间在一个大都市中心和一家大型内陆地区医院接受肾细胞癌（RCC）手术的 221 例患者进行回顾性分析。收集了年龄、性别、表现（偶然或症状性）、临床分期和病理特征的数据。澳大利亚标准地理分类-偏远地区（ASGC-RA）是一种用于允许对澳大利亚大都市和农村地区进行定量比较的系统。根据手术时患者居住地的位置为每位患者分配一个分数：大都市，RA1；内陆地区，RA2；偏远地区，RA3。Pearson 卡方检验指定统计显著性为 P < 0.05。
每组 ASGC-RA 患者在年龄、性别或表现方式上无显著差异。在 ASGC-RA 增加的情况下，即与三级中心的距离增加，就诊时的病理 T 分期也随之增加（P = 0.004）。在我们的三级中心治疗的 RA1 患者中，患有 ≥T3 疾病的患者比例从 30%上升至 RA3 患者的 73%（P = 0.016）。同样，我们的地区中心也有更多来自 RA3 的患者表现为 ≥T3 疾病（31%比 5%，P = 0.003）。当 221 例 RCC 患者作为一个整体进行分析时，临床 T 分期与 ASGC-RA（P < 0.001）、症状性表现（P < 0.001）、N 分期（P < 0.001）、M 分期（P < 0.001）和 Fuhrman 分级（P < 0.001）显著相关。
我们的数据量化了身体距离对澳大利亚地区肾癌患者健康结果的不利影响。澳大利亚独特的地理和农村文化可能会阻止像其他国家那样将癌症治疗集中到专门的大都市单位。
