美国上尿路尿路上皮癌患者的地域差异。
Regional differences in upper tract urothelial carcinoma patients across the United States.
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria.
出版信息
Urol Oncol. 2024 May;42(5):162.e1-162.e10. doi: 10.1016/j.urolonc.2024.01.034. Epub 2024 Feb 9.
BACKGROUND
It is unknown whether regional differences in patient, tumor, and treatment characteristics of upper tract urothelial carcinoma (UTUC) patients exist and may potentially result in regional overall mortality (OM) differences. We tested for inter-regional differences, according to Surveillance, Epidemiology, and End Results (SEER) registries.
METHODS
Using SEER database 2000 to 2016, patient (age, sex, race/ethnicity), tumor (location, grade) and treatment (nephroureterectomy, systemic therapy [ST]) characteristics of UTUC patients of all-stages were tabulated and graphically depicted in a stage-specific fashion (TNM vs. TNM vs. TNM/TNM). Multivariable Cox regression (MCR) models tested for inter-regional differences in OM.
RESULTS
Regarding TNM patients, statistically significant differences existed for race/ethnicity (Caucasian 71 vs. 98%), location (renal pelvis: 55 vs. 67%), grade (high 60 vs. 83%) and ST (5.5 vs. 13.9%). In MCR models, registries 3 (Hazard ratio [HR]:1.39; P < 0.001) and 4 (HR:1.31; P = 0.01) independently predicted higher OM and Registry 8 (HR:0.64; P = 0.001) lower OM. Regarding TNM patients, statistically significant differences existed for race/ethnicity (Caucasian 70 vs. 98%), location (renal pelvis: 67 vs. 76%), grade (high 84 vs. 94%) and ST (18.7 vs. 29.5%). In MCR models, registries 3 (HR:1.42; P < 0.001) and 4 (HR:1.31; P = 0.009) independently predicted higher OM. Regarding TNM/TNM patients, statistically significant differences existed for location (renal pelvis: 63 vs. 82%), grade (high 92 vs. 98%) and ST (53.4 vs. 58.8%). In MCR models, Registry 3 (HR:1.37; P = 0.004) independently predicted higher OM and Registry 2, (HR:0.78; P = 0.02) lower OM.
CONCLUSIONS
Inter-regional differences were recorded in patients, tumor, and treatment characteristics. Even after adjustment for these characteristics, OM differences persisted which may be indicative of regional differences in quality of care or expertise in UTUC management.
背景
上尿路上皮癌（UTUC）患者的患者、肿瘤和治疗特征是否存在地域差异，这些差异是否可能导致总体死亡率（OM）的地域差异尚不清楚。我们根据监测、流行病学和最终结果（SEER）登记处对此进行了测试。
方法
使用 SEER 数据库 2000 年至 2016 年，对所有分期 UTUC 患者的患者（年龄、性别、种族/民族）、肿瘤（位置、分级）和治疗（肾输尿管切除术、全身治疗[ST]）特征进行了列表和图形描绘（TNM 与 TNM 与 TNM/TNM）。多变量 Cox 回归（MCR）模型测试了 OM 的地域差异。
结果
在 TNM 患者中，种族/民族（白种人 71%对 98%）、位置（肾盂：55%对 67%）、分级（高 60%对 83%）和 ST（5.5%对 13.9%）存在统计学显著差异。在 MCR 模型中，登记处 3（危险比[HR]：1.39；P<0.001）和 4（HR：1.31；P=0.01）独立预测 OM 更高，登记处 8（HR：0.64；P=0.001）预测 OM 更低。在 TNM 患者中，种族/民族（白种人 70%对 98%）、位置（肾盂：67%对 76%）、分级（高 84%对 94%）和 ST（18.7%对 29.5%）存在统计学显著差异。在 MCR 模型中，登记处 3（HR：1.42；P<0.001）和 4（HR：1.31；P=0.009）独立预测 OM 更高。在 TNM/TNM 患者中，位置（肾盂：63%对 82%）、分级（高 92%对 98%）和 ST（53.4%对 58.8%）存在统计学显著差异。在 MCR 模型中，登记处 3（HR：1.37；P=0.004）独立预测 OM 更高，登记处 2（HR：0.78；P=0.02）预测 OM 更低。
结论
在患者、肿瘤和治疗特征方面存在地域差异。即使在调整了这些特征后，OM 差异仍然存在，这可能表明在 UTUC 管理方面存在护理质量或专业知识方面的地域差异。
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