Zeng Jiping, Batai Ken, Lee Benjamin R
Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA.
J Kidney Cancer VHL. 2021 Jun 14;8(2):27-33. doi: 10.15586/jkcvhl.v8i2.125. eCollection 2021.
In this study, we aimed to evaluate the impact of surgical wait time (SWT) on outcomes of patients with renal cell carcinoma (RCC), and to investigate risk factors associated with prolonged SWT. Using the National Cancer Database, we retrospectively reviewed the records of patients with pT3 RCC treated with radical or partial nephrectomy between 2004 and 2014. The cohort was divided based on SWT. The primary outcome was 5-year overall survival (OS). Logistic regression analysis was used to investigate the risk factors associated with delayed surgery. Cox proportional hazards models were fitted to assess relations between SWT and 5-year OS after adjusting for confounding factors. A total of 22,653 patients were included in the analysis. Patients with SWT > 10 weeks had higher occurrence of upstaging. Using logistic regression, we found that female patients, African-American or Spanish origin patients, treatment in academic or integrated network cancer center, lack of insurance, median household income of <$38,000, and the Charlson-Deyo score of ≥1 were more likely to have prolonged SWT. SWT > 10 weeks was associated with decreased 5-year OS (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15-1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, gender, race, insurance status, Charlson-Deyo score, tumor size, and surgical margin status (adjusted HR, 1.13; 95% CI, 1.04-1.24). In conclusion, the vast majority of patients underwent surgery within 10 weeks. There is a statistically significant trend of increasing SWT over the study period. SWT > 10 weeks is associated with decreased 5-year OS.
在本研究中，我们旨在评估手术等待时间（SWT）对肾细胞癌（RCC）患者预后的影响，并调查与SWT延长相关的危险因素。利用国家癌症数据库，我们回顾性分析了2004年至2014年间接受根治性或部分肾切除术的pT3期RCC患者的记录。根据SWT对队列进行分组。主要结局为5年总生存率（OS）。采用逻辑回归分析调查与手术延迟相关的危险因素。拟合Cox比例风险模型以评估在调整混杂因素后SWT与5年OS之间的关系。分析共纳入22,653例患者。SWT>10周的患者分期上调的发生率更高。通过逻辑回归分析，我们发现女性患者、非裔美国人或西班牙裔患者、在学术或综合网络癌症中心接受治疗、缺乏保险、家庭收入中位数<$38,000以及Charlson-Deyo评分为≥1的患者更有可能出现SWT延长。SWT>10周与5年OS降低相关（风险比[HR]，1.24；95%置信区间[CI]，1.15-1.33）。在调整包括年龄、性别、种族、保险状况、Charlson-Deyo评分、肿瘤大小和手术切缘状态等混杂变量后，这种风险并未明显减弱（调整后HR，1.13；95%CI，1.04-1.24）。总之，绝大多数患者在10周内接受了手术。在研究期间，SWT有统计学上显著的增加趋势。SWT>10周与5年OS降低相关。
