Minnillo Brian J, Tabayoyong William, Francis John J, Maurice Matthew J, Zhu Hui, Kim Simon, Abouassaly Robert
Urological Institute, University Hospitals Case Medical Centre, Case Western Reserve University, Cleveland, OH, United States.
Urology Section/Surgery Service, Louis Stokes Cleveland Veterans Affairs Medical Centre, Cleveland, OH, United States.
Can Urol Assoc J. 2017 May;11(5):E184-E191. doi: 10.5489/cuaj.4137. Epub 2017 May 9.
To determine tumour, patient, and provider factors associated with cytoreductive nephrectomy (CN) use and to identify those factors that predicted short-term and long-term surgical outcomes.
We performed a retrospective review (1998-2011) of the National Cancer Database, a U.S. population-based oncology outcomes database. The review included 36 549 patients with metastatic renal cell carcinoma (mRCC). We assessed predictors of CN use, length of stay (LOS), 30-day readmission, and 30-day mortality using multivariable logistic regression. The Cox proportional hazards model assessed predictors of overall survival (OS).
Overall, 10 809 (29.6%) patients received CN, increasing from 15.2% to 36.1% over time. Private insurance (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.16-1.37) and academic facilities (OR 1.83; 95% CI 1.68-1.99) were associated with receiving CN (p<0.0001). Charlson score ≥2 and older age group were less likely to undergo surgery (p<0.0001). Median LOS was five days (inter-quartile range [IQR] 3-7), while 30-day readmission and 30-day mortality were 5.3% and 3.3%, respectively. Undergoing CN (hazard ratio [HR] 0.48; 95% CI 0.44-0.52; p<0.0001) and treatment at academic centres (HR 0.88; 95% CI 0.81-0.95; p=0.001) were independently associated with improved OS. Limitation includes retrospective design with possible selection bias.
Increased CN use continues in the modern era, with relatively low surgical morbidity. Further study is required to determine if the finding of lower all-cause mortality in patients treated at academic centres is due to improved care or unmeasured confounders.
确定与减瘤性肾切除术（CN）使用相关的肿瘤、患者及医疗服务提供者因素，并识别那些预测短期和长期手术结果的因素。
我们对美国基于人群的肿瘤学结局数据库——国家癌症数据库进行了回顾性分析（1998 - 2011年）。该分析纳入了36549例转移性肾细胞癌（mRCC）患者。我们使用多变量逻辑回归评估了CN使用、住院时间（LOS）、30天再入院率及30天死亡率的预测因素。Cox比例风险模型评估了总生存期（OS）的预测因素。
总体而言，10809例（29.6%）患者接受了CN，随时间推移从15.2%增至36.1%。私人保险（比值比[OR] 1.26；95%置信区间[CI] 1.16 - 1.37）和学术机构（OR 1.83；95% CI 1.68 - 1.99）与接受CN相关（p<0.0001）。Charlson评分≥2及年龄较大组接受手术的可能性较小（p<0.0001）。中位住院时间为5天（四分位间距[IQR] 3 - 7），而30天再入院率和30天死亡率分别为5.3%和3.3%。接受CN（风险比[HR] 0.48；95% CI 0.44 - 0.52；p<0.0001）及在学术中心接受治疗（HR 0.88；95% CI 0.
