Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer.
Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer.
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DOI：
10.1001/jama.2012.475
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发表时间：
2012-04-18
影响因子：
120.7
通讯作者：
Miller, David C.
中科院分区：
文献类型：
--
作者：
Tan, Hung-Jui;Norton, Edward C.;Ye, Zaojun;Hafez, Khaled S.;Gore, John L.;Miller, David C.
尽管部分肾切除术是许多早期肾癌患者的首选治疗方法，但最近的临床试验数据显示，根治性肾切除术治疗的患者生存率更高，这给这些治疗方案的相对有效性带来了新的不确定性。我们试图通过一项工具变量分析来澄清这一问题，该分析比较了以人群为基础的患者队列中部分和根治性肾切除术后的长期生存率，这些患者的治疗反映了当代手术实践。我们对1992年至2007年间接受部分或根治性肾切除术的临床T1a期肾癌医疗保险受益人进行了回顾性队列研究。使用工具变量方法来解释治疗组之间测量和未测量的差异，我们拟合了一个两阶段残余包含模型来估计部分肾切除术对长期生存的治疗效果。总体生存率和肾癌特异性生存率。在7138名患有早期肾癌的医疗保险受益人中，我们确定了1925名（27.0%）接受部分肾切除术的患者和5213名（73.0%）接受根治性肾切除术的患者。在62个月的中位随访期间，分别有487例（25.3%）和2164例（41.5%）患者死于部分或根治性肾切除术。37例（1.9%）行部分肾切除术患者和222例（4.3%）行根治性肾切除术患者的死亡原因是肾癌。行部分肾切除术的患者死亡风险显著降低（HR 0.54, 95% CI 0.34-0.85）。这与部分肾切除术在治疗后2年、5年和8年的预测生存率分别增加5.6 （95% CI 1.9-9.3）、11.8 （95% CI 3.9-19.7）和15.5 （95% CI 5.0-26.0）个百分点相对应（p<0.001）。肾癌特异性生存率无差异（HR 0.82, 95% CI 0.19-3.49）。在患有早期肾癌的医疗保险受益人中，选择任何一种手术，部分肾切除术而不是根治性肾切除术与生存率的提高有关。
Although partial nephrectomy is the preferred treatment for many patients with early-stage kidney cancer, recent clinical trial data demonstrating better survival for patients treated with radical nephrectomy has generated new uncertainty regarding the comparative effectiveness of these treatment options. We sought to clarify this issue by performing an instrumental variable analysis comparing long-term survival after partial versus radical nephrectomy among a population-based patient cohort whose treatment reflects contemporary surgical practice. We performed a retrospective cohort study of Medicare beneficiaries with clinical stage T1a kidney cancer treated from 1992 through 2007 with partial or radical nephrectomy. Using an instrumental variable approach to account for measured and unmeasured differences between treatment groups, we fit a two-stage residual inclusion model to estimate the treatment effect of partial nephrectomy on long-term survival. Overall and kidney cancer-specific survival. Among 7,138 Medicare beneficiaries with early-stage kidney cancer, we identified 1,925 (27.0%) patients treated with partial nephrectomy, and 5,213 (73.0%) patients treated with radical nephrectomy. During a median follow-up of 62 months, 487 (25.3%) and 2,164 (41.5%) patients died following partial or radical nephrectomy, respectively. Kidney cancer was the cause of death for 37 (1.9%) patients treated with partial nephrectomy, and 222 (4.3%) patients treated with radical nephrectomy. Patients treated with partial nephrectomy had a significantly lower risk of death (HR 0.54, 95% CI 0.34-0.85). This corresponded to a predicted survival increase with partial nephrectomy of 5.6 (95% CI 1.9-9.3), 11.8 (95% CI 3.9-19.7), and 15.5 (95% CI 5.0-26.0) percentage points at 2-, 5-, and 8-years post-treatment (p<0.001). No difference was noted in kidney cancer-specific survival (HR 0.82, 95% CI 0.19-3.49). Among Medicare beneficiaries with early-stage kidney cancer who were candidates for either surgery, treatment with partial rather than radical nephrectomy was associated with improved survival.
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影响因子：
6.2
作者：
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