Age at diagnosis is a determinant factor of renal cell carcinoma-specific survival in patients treated with nephrectomy
Age at diagnosis is a determinant factor of renal cell carcinoma-specific survival in patients treated with nephrectomy
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DOI：
10.5489/cuaj.978
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发表时间：
2008-12-01
影响因子：
1.9
通讯作者：
Patard, Jean-Jacques
中科院分区：
文献类型：
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作者：
Karakiewicz, Pierre. I.;Jeldres, Claudio;Patard, Jean-Jacques
目的：基于4880名患者的综合数据，先前的两项研究报告称，高龄是肾癌特异性死亡率(RCC-SM)增加的预测因素。我们在三次样条法分析中探讨了年龄的影响，以确定肾细胞癌(RCC)风险最高的年龄组。方法：我们的研究包括来自14个欧洲中心的3595名接受部分或根治性肾切除术的患者。我们使用Kaplan-Meier方法编制生命表，并进行Cox回归分析以评估RCC-SM。协变量包括确诊年龄、性别、TNM分期(肿瘤、淋巴结、转移)、肿瘤大小、Fuhrman分级、症状分类和组织学亚型。结果：年龄从10岁到89岁(平均63岁，中位数67岁)。中位随访时间为2.9年。队列的中位生存期为13.4年。分期分布：I期1915例(53.3%)，II期388例(10.8%)，III期895例(24.9%)，IV期397例(11.0%)。在多变量分析中，我们将诊断时的年龄编码为三次样条法，并获得独立预测状态(p<；0.001)。在50岁以下的患者中，RCC-SM的风险最低。我们观察到RCC-SM在50岁之前增加，在这一点上风险水平达到平台期。在75-89岁的患者中，我们观察到第二次增加。当我们根据2002年美国癌症联合委员会(AJCC)的分期对患者进行分层时，我们发现了类似的模式。结论：年龄的影响具有预后意义，并表明随访和可能的二次治疗可能需要根据患者的年龄进行调整。
Objective: Based on combined data for 4880 patients, 2 previous studies reported that advanced age is a predictor of increased renal cell carcinoma-specific mortality (RCC-SM). We explored the effect of age in cubic spline analyses to identify the age groups with the most elevated risk for renal cell carcinoma (RCC).Methods: Our study included 3595 patients from 14 European centres who had partial or radical nephrectomies. We used the Kaplan-Meier method to compile life tables, and we performed Cox regression analyses to assess RCC-SM. Covariates included age at diagnosis, sex, TNM (tumour, node, metastasis) stage, tumour size, Fuhrman grade, symptom classification and histological subtype.Results: Age ranged from 10 to 89 (mean 63, median 67) years. The median duration of follow-up was 2.9 years. The median survival for the cohort was 13.4 years. Stage distribution was as follows: 1915 patients (53.3%) had stage I disease, 388 (10.8%) had stage II, 895 (24.9%) had stage III and 397 (11.0%) had stage IV disease. In multivariate analyses, we coded age at diagnosis as a cubic spline, and it achieved independent predictor status (p < 0.001). The risk of RCC-SM was lowest among patients younger than 50 years. We observed an increase in RCC-SM until the age of 50, at which point the level of risk reached a plateau. We observed a second increase among patients aged 75-89 years. We found similar patterns when we stratified patients according to the 2002 American Joint Committee on Cancer (AJCC) stages.Conclusion: The effect of age shows prognostic significance and indicates that follow-up and possibly secondary treatments might need to be adjusted according to the age of the patient.