诊断时的年龄与小肾癌的外科治疗：基于横断面人群的研究结果。

Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross-sectional population-based study.

机构信息

Deakin University, Burwood, Vic., Australia.

Cancer Council Victoria, Melbourne, Vic., Australia.

出版信息

BJU Int. 2018 Nov;122 Suppl 5:50-61. doi: 10.1111/bju.14585.

DOI:10.1111/bju.14585

PMID:30307688

Abstract

OBJECTIVES

To describe the use of partial nephrectomy (PN) for patients with stage T1a renal cell carcinoma (RCC) by age group (<65 and ≥65 years) in two Australian states.

MATERIALS AND METHODS

All adults diagnosed with RCC in 2012 and 2013 were identified through population-based cancer registries in the Australian states of Queensland and Victoria. For each patient, research assistants extracted patient, tumour and treatment data from medical records. Percentages of patients treated by PN were determined for the two age groups. Multivariable logistic regression analyses examined factors associated with PN. Clinicians treating RCC were sent surveys to assess attitudes towards PN.

RESULTS

Data were collected on 956 patients (Victoria: n = 548; Queensland: n = 404) with stage T1a RCC. Of those undergoing surgery (n = 865), PN was more common for those aged <65 years (61%) than for those aged ≥65 years (44%), with this difference significant after adjusting for patient, tumour (odds ratio 0.50, 95% confidence interval 0.36-0.70). There were significant interactions between age and treatment centre volume (P < 0.05) and residential state (P < 0.05). PN was less likely for younger patients treated at lower-volume hospitals (<24 patients a year) but hospital volume was not associated with PN for older patients. PN was less likely for older patients in Queensland than Victoria. In multivariable analyses, age was not related to laparoscopic surgery. Queensland clinicians were less likely than those from Victoria to agree that PN was the treatment of choice for most T1aN0M0 tumours (P < 0.001).

CONCLUSIONS

In Australia, patients aged > 65 years with small renal cancers were less likely to be treated by PN than younger patients. The variation in the surgical procedure used to treat older T1a RCC patients by state and hospital volume indicates that better evidence is needed to direct practice in this area.

摘要

目的

描述在澳大利亚两个州，按年龄组（<65 岁和≥65 岁）描述接受 T1a 期肾细胞癌（RCC）患者的部分肾切除术（PN）的使用情况。

材料和方法

通过澳大利亚昆士兰州和维多利亚州的基于人群的癌症登记处，确定了 2012 年和 2013 年诊断为 RCC 的所有成年人。对于每位患者，研究助理从病历中提取患者、肿瘤和治疗数据。确定了两个年龄组接受 PN 治疗的患者比例。多变量逻辑回归分析检查了与 PN 相关的因素。治疗 RCC 的临床医生收到了评估他们对 PN 态度的调查问卷。

结果

共收集了 956 例 T1a RCC 患者（维多利亚州：n = 548；昆士兰州：n = 404）的数据。在接受手术治疗的患者（n = 865）中，<65 岁的患者接受 PN 的比例（61%）明显高于≥65 岁的患者（44%），调整患者、肿瘤因素后差异具有统计学意义（比值比 0.50，95%置信区间 0.36-0.70）。年龄与治疗中心容量（P < 0.05）和居住州（P < 0.05）之间存在显著交互作用。在低容量医院（<24 例/年）治疗的年轻患者中，PN 的可能性较低，但对老年患者而言，医院容量与 PN 无关。昆士兰州的老年患者接受 PN 的可能性低于维多利亚州。在多变量分析中，年龄与腹腔镜手术无关。与维多利亚州的临床医生相比，昆士兰州的临床医生不太可能认为 PN 是大多数 T1aN0M0 肿瘤的首选治疗方法（P < 0.001）。