Bourlon Maria T, Remolina-Bonilla Yuly A, Acosta-Medina Aldo A, Saldivar-Oviedo Bruno I, Perez-Silva Antonio, Martinez-Ibarra Nayeli, Castro-Alonso Francisco Javier, Martín-Aguilar Ana E, Rivera-Rivera Samuel, Mota-Rivero Fernando, Pérez-Pérez Perla, Díaz-Alvarado María G, Ruiz-Morales José M, Campos-Gómez Saúl, Martinez-Cannon Bertha Alejandra, Lam Elaine T, Sobrevilla-Moreno Nora
Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Medical Oncology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico.
Front Oncol. 2023 Nov 17;13:1229016. doi: 10.3389/fonc.2023.1229016. eCollection 2023.
The survival of patients with metastatic renal cell carcinoma (mRCC) has improved dramatically due to novel systemic treatments. However, mRCC mortality continues to rise in Latin America.
A retrospective, multicenter study of patients diagnosed with mRCC between 2010-2018 in Mexico City was conducted. The aim of the study was to evaluate the impact of healthcare insurance on access to treatment and survival in patients with mRCC.
Among 924 patients, 55.4%, 42.6%, and 1.9% had no insurance (NI), social security, (SS) and private insurance (PI), respectively. metastatic disease was more common in NI patients (70.9%) compared to SS (47.2%) and PI (55.6%) patients (p<0.001). According to IMDC Prognostic Index, 20.2% were classified as favorable, 49% as intermediate, and 30.8% as poor-risk disease. Access to systemic treatment differed by healthcare insurance: 36.1%, 99.5%, and 100% for the NI, SS, and PI patients, respectively (p<0.001). NI patients received fewer lines of treatment, with 24.8% receiving only one line of treatment (p<0.001). Median overall survival (OS) was 13.9 months for NI, 98.9 months for SS, and 147.6 months for NI patients (p<0.001). In multivariate analysis, NI status, brain metastases, sarcomatoid features, bone metastases, no treatment were significantly associated with worse OS.
OS in mRCC was affected by insurance availability in this resource-limited cohort of Mexican patients. These results underscore the need for effective strategies to achieve equitable healthcare access in an era of effective, yet costly systemic treatments.
由于新型全身治疗方法的出现，转移性肾细胞癌（mRCC）患者的生存率有了显著提高。然而，在拉丁美洲，mRCC的死亡率仍在持续上升。
对2010年至2018年在墨西哥城诊断为mRCC的患者进行了一项回顾性多中心研究。该研究的目的是评估医疗保险对mRCC患者获得治疗和生存的影响。
在924例患者中，分别有55.4%、42.6%和1.9%没有保险（NI）、有社会保障（SS）和有私人保险（PI）。与SS（47.2%）和PI（55.6%）患者相比，转移性疾病在NI患者中更为常见（70.9%）（p<0.001）。根据国际转移性肾细胞癌数据库（IMDC）预后指数，20.2%被归类为低危，49%为中危，30.8%为高危疾病。获得全身治疗的情况因医疗保险而异：NI、SS和PI患者分别为36.1%、99.5%和100%（p<0.001）。NI患者接受的治疗线数较少，24.8%的患者仅接受一线治疗（p<0.001）。NI患者的中位总生存期（OS）为13.9个月，SS患者为98.9个月，PI患者为147. June months（p<0.001）。在多变量分析中，NI状态、脑转移、肉瘤样特征、骨转移、未接受治疗与较差的OS显著相关。
在这个资源有限的墨西哥患者队列中，mRCC的OS受保险可及性的影响。这些结果强调了在有效但昂贵的全身治疗时代，需要采取有效策略来实现公平的医疗服务可及性。
