Department of Urology, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC, Canada.
Division of Urology/Minimally Invasive Surgery, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada.
Urol Oncol. 2021 Aug;39(8):499.e15-499.e22. doi: 10.1016/j.urolonc.2021.05.026. Epub 2021 Jun 27.
The role of renal tumor biopsy (RTB) in the management of small renal masses (SRMs) is progressively being recognized as a tool to decrease overtreatment. While an increasing number of studies assessing its role in diagnostics are becoming available, RTB remains variably used amongst urologists. Many patient-, tumor-, and institution-related factors may influence urologists on whether to perform a RTB to help guide management.
We aimed at identifying factors associated with the use of RTB for localized SRMs within a number of centers contributing data to the Canadian Kidney Cancer information system.
We identified 3,838 patients diagnosed with a localized SRM (≤4 cm) between January 2011 and December 2018. Patients were stratified based on whether a RTB was performed prior to the primary therapeutic intervention. Factors associated with use of RTB were assessed using univariable and multivariable logistic regression models.
A total of 993 patients (25.9%) underwent an RTB. There was an overall increase in RTB use over time (P < 0.001), with patients diagnosed between 2015 and 2018 undergoing more RTB than patients diagnosed between 2011 and 2014 (29.8% vs. 22.2%, respectively; P < 0.001). Patients managed in centers with the highest patient-volume had RTB more frequently than patients managed in low-volume centers. On multivariable analysis, increasing year of diagnosis was significantly associated with more RTB use. Patients treated with surgery underwent RTB statistically less often than patients undergoing thermal ablation (P < 0.001) or managed with active surveillance (P < 0.001). Larger SRMs were associated with more RTB use in patients on active surveillance (P = 0.009), but with less RTB in patients undergoing surgery (P = 0.045).
This large multicenter cohort study reveals an increasing adoption and overall use of RTB amongst Canadian urologists. Patients managed in high-volume centers and those undergoing non-surgical management were associated with greater use of RTB. Tumor size was also associated with RTB use. This study highlights the influence that physician perceptions and clinical factors may have in the decision to use RTB prior to initiating a therapeutic approach.
肾肿瘤活检（RTB）在小肾肿瘤（SRM）管理中的作用逐渐被认为是减少过度治疗的一种手段。虽然越来越多的研究评估其在诊断中的作用，但泌尿科医生对 RTB 的使用仍存在差异。许多与患者、肿瘤和机构相关的因素可能会影响泌尿科医生是否进行 RTB 以帮助指导治疗。
我们旨在确定在加拿大肾脏癌症信息系统中提供数据的多个中心中，与局部 SRM 进行 RTB 相关的因素。
我们确定了 2011 年 1 月至 2018 年 12 月期间诊断为局部 SRM（≤4cm）的 3838 名患者。根据在主要治疗干预之前是否进行 RTB，对患者进行分层。使用单变量和多变量逻辑回归模型评估与 RTB 使用相关的因素。
共有 993 名患者（25.9%）接受了 RTB。随着时间的推移，RTB 的使用总体上有所增加（P<0.001），2015 年至 2018 年诊断的患者比 2011 年至 2014 年诊断的患者进行 RTB 的比例更高（分别为 29.8%和 22.2%；P<0.001）。在患者量最高的中心接受治疗的患者比在低容量中心接受治疗的患者更频繁地进行 RTB。多变量分析显示，诊断年份的增加与 RTB 使用的增加显著相关。与接受热消融（P<0.001）或接受主动监测（P<0.001）的患者相比，接受手术治疗的患者进行 RTB 的统计次数更少。在接受主动监测的患者中，较大的 SRM 与更多的 RTB 使用相关（P=0.009），但在接受手术的患者中，RTB 的使用较少（P=0.045）。
这项大型多中心队列研究揭示了加拿大泌尿科医生对 RTB 的采用和总体使用不断增加。在高容量中心接受治疗和接受非手术治疗的患者与 RTB 使用的增加相关。肿瘤大小也与 RTB 的使用相关。这项研究强调了医生的看法和临床因素可能对在开始治疗前使用 RTB 做出决策的影响。
