Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA.
Can J Urol. 2021 Oct;28(5):10806-10816.
To investigate the impact of facility type and volume on survival in patients with metastatic renal cell carcinoma (mRCC).
We investigated the National Cancer Database for patients with mRCC. Patients were stratified according to treatment facility type (academic vs. non-academic) and facility volume (high, intermediate, and low). Kaplan-Meier survival estimates and Cox proportional hazard models were fitted to evaluate overall survival (OS) as a function of facility type, volume, and different treatment modalities.
A total of 27,598 patients were identified, of which 10,938 (40%) were treated at academic centers (AC) and 16,131 (60%) at non-academic centers (non-AC). Overall, 19,904 patients (72%) were treated in high-volume hospitals (HVH). Among patients treated at AC, 94% were treated at HVHs. Patients treated at AC were more likely to receive immunotherapy, undergo cytoreductive nephrectomy (CN) and metastasectomy. The 2 and 5 year OS rates for patients treated in AC were 29.7% (CI 28.8%-30.6%) and 13% (CI 12%-14%) vs. 21.7% (CI 21%-22.4%) and 8.4% (CI %7.91-%8.99) in the Non-AC, respectively (p < 0.001). Multivariate Cox regression analysis identified treatment at AC as an independent predictor of survival (HR 0.85, 95% CI 0.81-0.91, p < 0.001). Undergoing CN and receipt of immunotherapy was also associated with a survival benefit (HR 0.41, CI 0.40-0.43 and HR 0.63, CI 0.59-0.68 respectively, p < 0.001).
Treatment at ACs and HVHs was associated with a survival benefit in patients with mRCC. Patients treated at AC were more likely to receive immunotherapy, undergo CN and metastasectomy.
研究医疗机构类型和规模对转移性肾细胞癌（mRCC）患者生存的影响。
我们研究了国家癌症数据库中患有 mRCC 的患者。根据治疗设施类型（学术与非学术）和设施规模（高、中、低）对患者进行分层。使用 Kaplan-Meier 生存估计和 Cox 比例风险模型评估整体生存率（OS）作为设施类型、规模和不同治疗方式的函数。
共确定了 27598 名患者，其中 10938 名（40%）在学术中心（AC）接受治疗，16131 名（60%）在非学术中心（非-AC）接受治疗。总体而言，19904 名患者（72%）在高容量医院（HVH）接受治疗。在接受 AC 治疗的患者中，94%在 HVH 接受治疗。接受 AC 治疗的患者更有可能接受免疫治疗、接受肾细胞减瘤术（CN）和转移灶切除术。在 AC 接受治疗的患者中，2 年和 5 年 OS 率分别为 29.7%（CI 28.8%-30.6%）和 13%（CI 12%-14%），而非-AC 中分别为 21.7%（CI 21%-22.4%）和 8.4%（CI %7.91-%8.99%）（p<0.001）。多变量 Cox 回归分析确定在 AC 接受治疗是生存的独立预测因素（HR 0.85，95%CI 0.81-0.91，p<0.001）。接受 CN 和接受免疫治疗也与生存获益相关（HR 0.41，CI 0.40-0.43 和 HR 0.63，CI 0.59-0.68，p<0.001）。
在 mRCC 患者中，在 AC 和 HVH 接受治疗与生存获益相关。在 AC 接受治疗的患者更有可能接受免疫治疗、接受 CN 和转移灶切除术。
