Mazzone Elio, Nazzani Sebastiano, Preisser Felix, Tian Zhe, Marchioni Michele, Bandini Marco, Capitanio Umberto, Kapoor Anil, Tilki Derya, Montorsi Francesco, Shariat Shahrokh F, Saad Fred, Briganti Alberto, I Karakiewicz Pierre
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Cancer Epidemiol. 2018 Oct;56:118-125. doi: 10.1016/j.canep.2018.08.006. Epub 2018 Aug 30.
Partial nephrectomy (PN) is technically feasible in patients with metastatic renal cell carcinoma (mRCC). We tested the contemporary effect of PN on cancer-specific mortality (CSM), other-cause mortality (OCM) and early postoperative outcomes compared to radical nephrectomy (RN) in mRCC patients.
In the first part, we identified surgically treated mRCC patients within the SEER database (2004-2013). After propensity-score (PS) matching, cumulative incidence plots and multivariable competing-risks regression (CRR) models were used. In the second part, we identified surgically treated mRCC patients within the NIS database (2004-2013). After PS matching, multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used.
Within the SEER database, 217 (4.2%) of 5171 mRCC patients underwent PN. After 4:1 PS matching, multivariable CRR models showed lower OCM rates in PN patients (hazard ratio [HR]: 0.23, p = 0.01). No difference in CSM was reported in PN vs. RN patients (p = 0.08). Within the NIS database, 226 (4.4%) of 5138 patients underwent PN. After 4:1 PS matching, MLR showed lower rates of transfusions (odds ratio [OR]: 0.46, P < 0.001), intraoperative (OR: 0.33, p = 0.02) and miscellaneous surgical complications (OR: 0.42, p = 0.009) in PN vs. RN patients. No difference in overall complications (OR: 1.00, p = 0.9) and in-hospital mortality (OR: 1.2, p = 0.8) was observed. In MPR, PN did not affect LOS (OR: 0.94, p = 0.3).
We demonstrate that PN is associated with lower OCM in the setting of mRCC, but not with differences in other examined endpoints. In consequence, PN merits greater consideration in the context of mRCC.
对于转移性肾细胞癌（mRCC）患者，部分肾切除术（PN）在技术上是可行的。我们比较了PN与根治性肾切除术（RN）对mRCC患者癌症特异性死亡率（CSM）、其他原因死亡率（OCM）和术后早期结局的当代影响。
在第一部分中，我们在监测、流行病学与最终结果（SEER）数据库（2004 - 2013年）中识别接受手术治疗的mRCC患者。在倾向评分（PS）匹配后，使用累积发病率图和多变量竞争风险回归（CRR）模型。在第二部分中，我们在国家住院患者样本（NIS）数据库（2004 - 2013年）中识别接受手术治疗的mRCC患者。在PS匹配后，使用多变量逻辑回归（MLR）和多变量泊松回归（MPR）模型。
在SEER数据库中，5171例mRCC患者中有217例（4.2%）接受了PN。在4:1 PS匹配后，多变量CRR模型显示PN患者的OCM率较低（风险比[HR]：0.23，p = 0.01）。PN与RN患者的CSM无差异（p = 0.08）。在NIS数据库中
