Metcalf Meredith R, Cheaib Joseph G, Wainger Julia, Peña Vanessa N, Patel Hiten D, Singla Nirmish, Pierorazio Phillip M
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
Urology. 2021 May;151:129-137. doi: 10.1016/j.urology.2020.08.041. Epub 2020 Sep 2.
To evaluate gender differences in the management of clinical T1a (cT1a) renal cell carcinoma (RCC) before and after release of the AUA guidelines for management in 2009, which prioritized nephron-sparing approaches.
Patients aged ≥66 years diagnosed with cT1a RCC from 2004 to 2013 in Surveillance, Epidemiology, and End Results-Medicare were analyzed. Multivariable mixed-effects logistic regression models were used to evaluate factors associated with radical nephrectomy (RN) for cT1a RCC before (2004 to 2009) and after (2010 to 2013) guidelines release. Predictors of pathologic T3 upstaging and high grade pathology in the postguidelines period were examined using multivariable logistic regression among patients who underwent RN or partial nephrectomy.
Twelve thousand four hundred and two patients with cT1a RCC were identified, 42% of whom were women. Overall, the likelihood of RN decreased postguidelines (odds ratio [OR] = 0.44, P <.001), but women were at increased odds of undergoing RN both before and after guideline release (OR = 1.27, P <.001 and OR = 1.37, P <.001, respectively) upon multivariable mixed-effects logistic regression. Tumor size >2 cm was also associated with increased likelihood of RN before and after guidelines (OR = 2.61, P <.001 and OR = 2.51, P <.001, respectively). In the postguidelines period, women had significantly lower odds of pathologic upstaging (OR = 0.75, P = .024) and harboring high grade pathology (OR = 0.71, P <.001) compared to men.
Gender differences persist in the management of cT1a RCC, with women having higher odds of undergoing RN, even after release of AUA guidelines and despite having lower odds of pathologic upstaging and high-grade disease.
评估2009年美国泌尿外科学会（AUA）发布肾细胞癌（RCC）管理指南前后，临床T1a期（cT1a）肾细胞癌管理中的性别差异，该指南优先考虑保留肾单位的方法。
分析2004年至2013年在监测、流行病学和最终结果-医疗保险计划中诊断为cT1a期肾细胞癌且年龄≥66岁的患者。采用多变量混合效应逻辑回归模型评估指南发布前（2004年至2009年）和发布后（2010年至2013年）与cT1a期肾细胞癌根治性肾切除术（RN）相关的因素。在接受RN或部分肾切除术的患者中，使用多变量逻辑回归检查指南发布后病理T3期升级和高分级病理的预测因素。
共识别出12402例cT1a期肾细胞癌患者，其中42%为女性。总体而言，指南发布后RN的可能性降低（比值比[OR]=0.44，P<.001），但在多变量混合效应逻辑回归分析中，女性在指南发布前后接受RN的几率均增加（OR分别为1.27，P<.001和OR为1.37，P<.001）。肿瘤大小>2 cm在指南发布前后也与RN可能性增加相关（OR分别为2.61，P<.001和OR为2.51，P<.001）。在指南发布后时期，与男性相比，女性病理分期升级（OR=0.75，P=.024）和存在高分级病理（OR=0.71，P<.001）的几率显著降低。
cT1a期肾细胞癌管理中性别差异仍然存在，即使在AUA指南发布后，女性接受RN的几率更高，尽管其病理分期升级和高级别疾病的几率较低。
