Faiena Izak, Dombrovskiy Viktor, Koprowski Christopher, Singer Eric A, Jang Thomas L, Weiss Robert E
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.
Can J Urol. 2014 Dec;21(6):7520-7.
To investigate the trends in the performance of radical cystectomy (RC) versus partial cystectomy (PC) in the United States over the past 10 years and compare postoperative outcomes between two procedures.
The data was captured from the Nationwide Inpatient Sample (NIS) 2001-2010 using the appropriate ICD-9-CM diagnosis and procedure codes. Patient sociodemographics, comorbidities and in-hospital complications after PC and RC were compared, taking into account some hospital characteristics. A chi-square analysis including a Cochran-Armitage trend test and a multivariable logistic regression analysis were employed.
RC rate increased from 84.8% in 2001 to 90.3% in 2010, while PC decreased from 15.2% to 9.7% (p < 0.0001). PC patients were older than their RC counterparts (72.1 ± 11.3 versus 68.6 ± 10.1 years; p < 0.0001), had higher prevalence of major comorbidities, but decreased rate of postoperative complications overall (21.3% versus 38.6%; p < 0.001). The greatest rates of PC utilization were found in the Northeast and South (12.8% and 12.7%). The frequency of PC was 18.9% in non-teaching hospitals compared to 9.0% in teaching hospitals (p < 0.0001). In multivariate analysis, females, octogenarians, patients with hypertension and obesity, and patients in non-teaching and rural hospitals were more likely to receive PC.
Despite the potential advantages in cancer control offered by RC, PC is being performed more frequently on the elderly, female patients, patients with hypertension and obesity, in non-teaching and rural hospitals, and in certain United States geographic regions, which can be partially explained by disparities in access to high volume cancer centers.
调查过去10年美国根治性膀胱切除术（RC）与部分膀胱切除术（PC）的实施趋势，并比较两种手术的术后结果。
使用适当的ICD-9-CM诊断和手术编码，从2001 - 2010年全国住院患者样本（NIS）中获取数据。比较了PC和RC术后患者的社会人口统计学、合并症及院内并发症，并考虑了一些医院特征。采用了包括 Cochr an-Armitage趋势检验的卡方分析和多变量逻辑回归分析。
RC率从2001年的84.8%增至2010年的90.3%，而PC率从15.2%降至9.7%（p < 0.0001）。PC患者比RC患者年龄更大（72.1±11.3岁对68.6±10.1岁；p < 0.0001），主要合并症患病率更高，但总体术后并发症发生率较低（21.3%对38.6%；p < 0.001）。PC使用率最高的地区是东北部和南部（分别为12.8%和12.7%）。非教学医院的PC频率为18.9%，而教学医院为9.0%（p < 0.0001）。多变量分析显示，女性、八旬老人、高血压和肥胖患者，以及非教学医院和农村医院的患者更有可能接受PC。
尽管RC在癌症控制方面具有潜在优势，但PC在老年患者、女性患者、高血压和肥胖患者、非教学医院和农村医院以及美国某些地理区域的实施频率更高，这部分可以通过获得大型癌症中心的机会差异来解释。
