Prognostic Value of Histologic Subtype and Treatment Modality for T1a Kidney Cancers.
Prognostic Value of Histologic Subtype and Treatment Modality for T1a Kidney Cancers.
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DOI：
10.3233/kca-190072
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Bjurlin MA
中科院分区：
文献类型：
--
作者：
Siev M;Renson A;Tan HJ;Rose TL;Kang SK;Huang WC;Bjurlin MA
按组织学亚型和包括肾部分切除术（PN）、经皮消融术（PA）以及根治性肾切除术（RN）在内的根治性治疗对T1a期肾癌的总生存期（OS）进行评估。
我们查询了美国国家癌症数据库（2004 - 2015年）中接受手术治疗的T1a期肾癌患者的信息。根据组织学亚型和治疗方法，通过卡普兰 - 迈耶曲线估算总生存期。采用考克斯比例回归模型来确定组织学亚型和治疗方法是否可预测总生存期。
46014例T1a期肾癌符合纳入标准。卡普兰 - 迈耶曲线显示，对于透明细胞型、乳头状型、嫌色细胞型和囊性组织学亚型，不同治疗方法的总生存期存在差异（均p < 0.001），但在肉瘤样型（p = 0.110）或集合管型（p = 0.392）中未观察到差异。校正后的考克斯回归分析显示，在透明细胞型（风险比1.58，95%置信区间[1.44 - 1.73]）、乳头状肾细胞癌（1.53[1.34 - 1.75]）和嫌色细胞型肾细胞癌（2.19[1.64 - 2.91]）患者中，经皮消融术的总生存期比肾部分切除术差。对于透明细胞型（风险比1.38[1.28 - 1.50]）、乳头状型（1.34[1.16 - 1.56]）和嫌色细胞型肾细胞癌（1.92[1.43 - 2.58]），根治性肾切除术的总生存期比肾部分切除术差。仅纳入组织学和手术方法的考克斯比例风险预测模型的预测能力有限（一致性指数0.63），而加入人口统计学因素后对总生存期具有一定的预测能力（一致性指数0.73）。
在病理为T1a期肾细胞癌的患者中，总生存期的模式因手术方式和组织学亚型而异。接受肾部分切除术的患者似乎比接受经皮消融术和根治性肾切除术的患者预后更好。然而，与代表竞争风险的变量相比，将组织学亚型和治疗方式纳入风险分层模型以预测总生存期的效用有限。
To evaluate overall survival (OS) of T1a kidney cancers stratified by histologic subtype and curative treatment including partial nephrectomy (PN), percutaneous ablation (PA), and radical nephrectomy (RN). We queried the National Cancer Data Base (2004–2015) for patients with T1a kidney cancers who were treated surgically. OS was estimated by Kaplan-Meier curves based on histologic subtype and management. Cox proportional regression models were used to determine whether histologic subtypes and management procedure predicted OS. 46,014 T1a kidney cancers met inclusion criteria. Kaplan Meier curves demonstrated differences in OS by treatment for clear cell, papillary, chromophobe, and cystic histologic subtypes (all p < 0.001), but no differences for sarcomatoid (p = 0.110) or collecting duct (p = 0.392) were observed. Adjusted Cox regression showed worse OS for PA than PN among patients with clear cell (HR 1.58, 95%CI [1.44–1.73], papillary RCC (1.53 [1.34–1.75]), and chromophobe RCC (2.19 [1.64–2.91]). OS was worse for RN than PN for clear cell (HR 1.38 [1.28–1.50]) papillary (1.34 [1.16–1.56]) and chromophobe RCC (1.92 [1.43–2.58]). Predictive models using Cox proportional hazards incorporating histology and surgical procedure alone were limited (c-index 0.63) while adding demographics demonstrated fair predictive power for OS (c-index 0.73). In patients with pathologic T1a RCC, patterns of OS differed by surgery and histologic subtype. Patients receiving PN appears to have better prognosis than both PA and RN. However, the incorporation of histologic subtype and treatment modality into a risk stratification model to predict OS had limited utility compared with variables representing competing risks.
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影响因子：
23.4
作者：
Moch, Holger;Cubilla, Antonio L.;Ulbright, Thomas M.
通讯作者：
Ulbright, Thomas M.
影响因子：
45.3
作者：
Kutikov, Alexander;Egleston, Brian L.;Uzzo, Robert G.
通讯作者：
Uzzo, Robert G.
影响因子：
6.6
作者：
Méjean, A;Hopirtean, V;Dufour, B
通讯作者：
Dufour, B
影响因子：
6.6
作者：
Campbell, Steven;Uzzo, Robert G.;Pierorazio, Philip M.
通讯作者：
Pierorazio, Philip M.
影响因子：
39.2
作者：
Talenfeld AD;Gennarelli RL;Elkin EB;Atoria CL;Durack JC;Huang WC;Kwan SW
通讯作者：
Kwan SW