Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes?
Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes?
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DOI：
10.1016/j.juro.2008.09.017
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发表时间：
2009-01
期刊：
影响因子：
--
通讯作者：
Russo P
中科院分区：
文献类型：
--
作者：
Huang WC;Elkin EB;Levey AS;Jang TL;Russo P
根治性肾切除术(RN)与部分肾切除术(PN)相比，增加了慢性肾脏疾病的风险，而慢性肾脏疾病是心血管事件(CV)和死亡的重要危险因素。如果在小肾肿瘤(RTS)患者中给予同等的肿瘤学疗效，RN可能会导致过度治疗。我们分析了一组基于人群的患者，以确定与PN相比，RN是否与心血管事件和死亡率的增加有关。使用与医疗保险索赔相关的监测、流行病学和最终结果(SEER)癌症登记数据，我们确定了1995至2002年间接受RN或PN治疗的2991名年龄超过65岁的RTS为4 cm或更小的患者。使用Kaplan-Meier生存估计、Cox比例风险回归和负二项回归评估心血管事件的主要终点和总存活率。共有2547名患者(81%)接受了RN，556名(19%)接受了PN。在中位数4年的随访中，609名患者发生了心血管事件，892名患者死亡。调整了术前人口统计学和并存变量，RN与总体死亡率增加(风险比1.38，P<；0.01)和术后心血管事件的数量增加1.4倍相关(P<；0.05)。然而，RN与首次发生心血管事件的风险(HR 1.21，P=0.10)或心血管死亡的风险(HR 0.95，P=0.84)无关。RN是目前最常见的治疗小RTS的方法，与PN相比，RN可能与显著的不良反应有关。对于大多数RTS较小的患者，应考虑使用PN。
Radical nephrectomy (RN), compared with partial nephrectomy (PN), increases the risk of chronic kidney disease, a significant risk factor for cardiovascular (CV) events and death. Given equivalent oncologic efficacy in patients with small renal tumors (RTs), RN may result in overtreatment. We analyzed a population-based cohort of patients to determine if RN is associated with an increase in CV events and mortality compared with PN. Using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, we identified 2991 patients older than 65 years of age treated with RN or PN for RTs 4 cm or smaller between 1995 and 2002. Primary end points of CV events and overall survival were assessed using Kaplan-Meier survival estimation, Cox proportional hazards regression, and negative binomial regression. A total of 2547 (81%) patients underwent RN and 556 (19%) underwent PN. During a median follow-up of 4 years, 609 patients had a CV event and 892 patients died. Adjusting for preoperative demographic and comorbid variables, RN was associated with an increased risk of overall mortality (hazard ratio [HR] 1.38, P<0.01) and a 1.4 times greater number of CV events after surgery (P<0.05). RN, however, was not associated with an increased risk of time to first CV event (HR 1.21, P=0.10) or CV death (HR 0.95, P=0.84). RN, currently the most common treatment for small RTs, may be associated with significant, adverse treatment effects compared with PN. PN should be considered for most patients with small RTs.
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影响因子：
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