挪威全国范围内手术治疗≤7cm 肾肿瘤的实践模式：遵循指南的变化可能会提高整体生存率。

National Norwegian Practice Patterns for Surgical Treatment of Kidney Cancer Tumors ≤7cm: Adherence to Changes in Guidelines May Improve Overall Survival.

机构信息

Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Cancer Registry of Norway, Oslo, Norway.

出版信息

Eur Urol Oncol. 2018 Aug;1(3):252-261. doi: 10.1016/j.euo.2018.04.001. Epub 2018 May 15.

BACKGROUND

Guidelines on surgical treatment for kidney cancer (KC) have changed over the last 10 yr. We present population-based data for patients with KC tumors ≤7cm from 2008 to 2013 to investigate whether surgical practice in Norway has changed according to guidelines.

OBJECTIVE

To assess the predictors of treatment and survival after KC surgery.

DESIGN, SETTING, AND PARTICIPANTS: We identified all surgically treated KC patients with tumors ≤7cm without metastasis diagnosed during 2008-2013 (2420 patients) from the Cancer Registry of Norway.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Relationships with outcomes were analyzed using joinpoint regression, multivariate logistic regression, Kaplan-Meier survival estimates, Cox regression, relative survival (RS), and competing-risk analyses.

RESULTS AND LIMITATIONS

The mean follow-up was 5.2 yr. There was a 28% increase in the number of patients undergoing surgical treatment over the study period. Joinpoint regression revealed a significant annual increase in partial nephrectomy (PN) and a small reduction in radical nephrectomy (RN). PN increased from 43% to 66% for tumors ≤4cm and from 10% to 18% for tumors of 4.1-7cm. Minimally invasive (MI) RN increased from 53% to 72% and MI PN from 25% to 64%, of which 55% of procedures were performed with robotic assistance in 2013. The geographical distribution of treatment approaches differed significantly. Both PN and MI approaches were more frequent in high-volume hospitals. Cox regression analysis revealed that PN, age, and Fuhrman grade and stage were independent predictors of survival. There were no significant differences in cancer-specific survival (p=0.8). The 5-yr RS for T1a disease was higher after PN than after RN.

CONCLUSIONS

The rate of PN for tumors ≤7cm increased in the 6-yr study period. MI approaches increased for both RN and PN. This treatment shift coincides with the new guideline recommendations in 2010. The possible better survival for patients undergoing PN compared to RN indicates the importance of following evidence-based guidelines.

PATIENT SUMMARY

The use of partial nephrectomy and minimally invasive surgery for kidney cancer tumors increased in Norway from 2008 to 2013 according to population-based data, coinciding with guideline changes. The study illustrate that adherence to guidelines may improve patient outcomes.

背景

过去 10 年来，关于肾癌（KC）的外科治疗指南发生了变化。我们呈现了 2008 年至 2013 年期间患有肿瘤≤7cm 的 KC 患者的基于人群的数据，以调查挪威的外科实践是否根据指南发生了变化。

目的

评估 KC 手术后治疗和生存的预测因素。

设计、设置和参与者：我们从挪威癌症登记处确定了所有在 2008-2013 年间诊断为无转移的手术治疗 KC 患者（2420 例）。

结局测量和统计分析

使用 joinpoint 回归、多变量逻辑回归、Kaplan-Meier 生存估计、Cox 回归、相对生存（RS）和竞争风险分析来分析与结局的关系。

结果和局限性

平均随访时间为 5.2 年。研究期间，接受手术治疗的患者数量增加了 28%。joinpoint 回归显示部分肾切除术（PN）的年增长率显著，根治性肾切除术（RN）略有减少。PN 从肿瘤≤4cm 的 43%增加到 66%，从肿瘤 4.1-7cm 的 10%增加到 18%。微创（MI）RN 从 53%增加到 72%，MI PN 从 25%增加到 64%，其中 2013 年有 55%的手术是使用机器人辅助进行的。治疗方法的地理分布差异显著。高容量医院更常采用 PN 和 MI 方法。Cox 回归分析显示，PN、年龄、Fuhrman 分级和分期是生存的独立预测因素。在癌症特异性生存方面没有显著差异（p=0.8）。PN 后 T1a 疾病的 5 年 RS 高于 RN。

结论

在 6 年的研究期间，肿瘤≤7cm 的 PN 率增加。MI 方法在 RN 和 PN 中均有所增加。这种治疗转变与 2010 年新指南建议一致。与 RN 相比，PN 后患者的生存可能更好，这表明遵循循证指南的重要性。

患者总结

根据基于人群的数据，2008 年至 2013 年，挪威部分肾切除术和微创手术治疗肾癌的应用有所增加，与指南变化一致。该研究表明，遵循指南可能会改善患者的结局。