Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
Department of Radiation Oncology, UC San Diego School of Medicine, La Jolla, CA.
Urol Oncol. 2021 Jan;39(1):79.e1-79.e8. doi: 10.1016/j.urolonc.2020.10.015. Epub 2020 Nov 5.
To evaluate trends and factors predicting use of renal mass biopsy (RMB) for localized Renal Cell Carcinoma in the United States (US) in the context of current guidelines recommendations.
We queried the National Cancer Database for cT1-cT3N0M0 Renal Cell Carcinoma diagnosed between 2004 and 2015. Temporal trends of RMB were characterized based on tumor size, treatment (partial nephrectomy [PN], radical nephrectomy [RN], ablation, and no treatment), age and Charlson Comorbidity Index with slopes compared using analysis of variance. Multivariable analysis was used to determine factors associated with use of RMB.
Of 338,252 patients analyzed, 11.9% (40,276) underwent RMB. Use of RMB increased throughout the study period from 1,586 (7.6%) in 2004 to 5,629 (16.2%) in 2015 (P < 0.001). Use of RMB increased greatest for ablation (27 to 63%, P < 0.001) and tumors 2-4 cm (9 to 20%, P < 0.001). Multivariable analysis showed year of diagnosis (OR = 1.06; P < 0.001), higher education (OR = 1.09; P < 0.001) and insured status (OR = 1.23; P < 0.001) were associated with increased RMB. Compared to tumors ≤2 cm, tumors 2.1-4 cm (OR = 1.36; P=<0.001), 4.1-7 cm (OR = 1.18; P <0.001) and >7 cm (OR = 1.05; P = 0.03) were associated with higher rates of RMB. Compared to RN, PN was not associated with increased RMB (OR = 1.00; P = 0.92), while ablation (OR = 10.90; P < 0.001) and no surgical treatment (OR = 4.83; P < 0.001) were.
RMB utilization increased overall, with largest increase associated with ablation. Nonetheless, only two-thirds of patients underwent RMB with ablation, suggesting persistent underutilization. Rates of RMB for tumors ≤2 cm and in those undergoing no treatment increased less, suggesting less utilization for surveillance. However, rates for tumors >2-4 cm increased more, suggesting selective utilization of RMB to guide decision-making and risk stratification in small renal masses.
评估美国在当前指南建议背景下，局部肾细胞癌患者行肾脏肿块活检（RMB）的趋势和预测因素。
我们在国家癌症数据库中查询了 2004 年至 2015 年间诊断为 cT1-cT3N0M0 肾细胞癌的患者。根据肿瘤大小、治疗方法（部分肾切除术[PN]、根治性肾切除术[RN]、消融术和未治疗）、年龄和 Charlson 合并症指数，采用方差分析比较斜率，来描述 RMB 的时间趋势。采用多变量分析确定与 RMB 使用相关的因素。
在分析的 338252 名患者中，11.9%（40276 名）接受了 RMB。从 2004 年的 1586 例（7.6%）到 2015 年的 5629 例（16.2%），整个研究期间 RMB 的使用率均呈上升趋势（P<0.001）。使用率增加最大的是消融术（从 27%增加到 63%，P<0.001）和 2-4 厘米的肿瘤（从 9%增加到 20%，P<0.001）。多变量分析显示，诊断年份（OR=1.06；P<0.001）、更高的教育程度（OR=1.09；P<0.001）和保险状态（OR=1.23；P<0.001）与 RMB 使用率的增加有关。与≤2 厘米的肿瘤相比，2.1-4 厘米（OR=1.36；P<0.001）、4.1-7 厘米（OR=1.18；P<0.001）和>7 厘米（OR=1.05；P=0.03）的肿瘤与更高的 RMB 使用率相关。与 RN 相比，PN 与 RMB 使用率的增加无关（OR=1.00；P=0.92），而消融术（OR=10.90；P<0.001）和无手术治疗（OR=4.83；P<0.001）与 RMB 使用率的增加有关。
总体而言，RMB 的使用率有所增加，最大的增长与消融术有关。尽管如此，只有三分之二的患者接受了 RMB 加消融术，表明其仍存在使用率不足的问题。≤2 厘米肿瘤和未治疗肿瘤的 RMB 使用率增长较少，表明对监测的使用率较低。然而，>2-4 厘米肿瘤的使用率增长更多，表明 RMB 被选择性用于指导小肾肿块的决策和风险分层。
