Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Eur Urol Oncol. 2019 Nov;2(6):691-698. doi: 10.1016/j.euo.2018.10.005. Epub 2018 Nov 16.
Radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT) is a complicated procedure for which the impact of hospital case volume on overall survival (OS) is unknown.
To assess the degree to which renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVC-TT) care is centralized and to evaluate the impact of hospital case volume on outcomes following RN-IVCT.
DESIGN, SETTING, AND PARTICIPANTS: The National Cancer Data Base was queried for patients with pT3b-c RCC treated with RN-IVCT. Hospitals were classified by case volume percentile as low (<75th percentile, <0.67 cases annually), intermediate (75th-95th percentile, 0.67-2.99 cases annually), or high (>95th percentile, >3 cases annually).
The primary outcome was OS. Secondary outcomes were short-term (30- and 90-d) mortality rates according to hospital case volume. Kaplan-Meier curves and Cox regression model were used to evaluate OS and the effect of covariables.
There were 2664 cases of RN-IVCT for pT3b-c tumors reported by 573 institutions, of which 435, 108, and 30 were classified as low, intermediate, and high volume, accounting for 28.5%, 34.5%, and 37% of cases, respectively. Treatment at high-volume institutions was associated with better OS: the median OS was 42, 53, and 60 months for low, intermediate and high-volume centers, respectively (p=0.009). After multivariable adjustment, treatment at a high-volume institution was associated with a 24% relative risk reduction for all-cause mortality compared to treatment at a low-volume institution (hazard ratio 0.76, 95% confidence interval 0.65-0.89; p=0.001). There was no significant difference in short-term mortality following RN-IVCT when stratified by hospital case volume.
Higher hospital case volume was associated with longer OS for patients undergoing RN-IVCT. These findings support efforts to centralize care for cases of advanced RCC.
In this study we looked at the impact of hospital case volume on survival following surgery for renal cell carcinoma and inferior vena cava thrombectomy. Survival was significantly better in high-volume hospitals performing three or more procedures per year.
肾静脉下腔静脉血栓切除术（RN-IVCT）是一种复杂的手术，目前尚不清楚医院病例量对总生存率（OS）的影响。
评估肾细胞癌（RCC）伴下腔静脉肿瘤血栓（IVC-TT）治疗的集中程度，并评估医院病例量对 RN-IVCT 后结果的影响。
设计、设置和参与者：国家癌症数据库（National Cancer Data Base）对接受 RN-IVCT 治疗的 pT3b-cRCC 患者进行了查询。根据病例量百分位数，医院分为低（<第 75 百分位，<0.67 例/年）、中（75-95 百分位，0.67-2.99 例/年）或高（>95 百分位，>3 例/年）。
主要结果是 OS。次要结果是根据医院病例量的短期（30 天和 90 天）死亡率。Kaplan-Meier 曲线和 Cox 回归模型用于评估 OS 和协变量的影响。
报告了 573 家机构的 2664 例 pT3b-c 肿瘤的 RN-IVCT，其中 435、108 和 30 例分别归类为低、中、高容量，分别占病例的 28.5%、34.5%和 37%。在高容量机构接受治疗与更好的 OS 相关：低、中、高容量中心的中位 OS 分别为 42、53 和 60 个月（p=0.009）。多变量调整后，与低容量中心相比，在高容量中心治疗与全因死亡率降低 24%相关（风险比 0.76，95%置信区间 0.65-0.89；p=0.001）。按医院病例量分层时，RN-IVCT 后短期死亡率无显著差异。
医院病例量较高与接受 RN-IVCT 的患者的 OS 延长相关。这些发现支持为晚期 RCC 病例集中治疗而努力。
在这项研究中，我们研究了医院病例量对肾细胞癌和下腔静脉血栓切除术患者手术生存的影响。每年进行 3 次或更多手术的高容量医院的生存率显著提高。
