Understanding Treatment Disconnect and Mortality Trends in Renal Cell Carcinoma Using Tumor Registry Data.
Understanding Treatment Disconnect and Mortality Trends in Renal Cell Carcinoma Using Tumor Registry Data.
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DOI：
10.1097/mlr.0000000000000657
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发表时间：
2017-04
期刊：
影响因子：
3
通讯作者：
Kutikov A
中科院分区：
文献类型：
--
作者：
Smaldone MC;Egleston B;Hollingsworth JM;Hollenbeck BK;Miller DC;Morgan TM;Kim SP;Malhotra A;Handorf E;Wong YN;Uzzo RG;Kutikov A
尽管肾细胞癌（RCC）的检测和治疗有所增加，但总体死亡率和癌症特异性死亡率却出现了矛盾的上升，这被称为“治疗脱节”。我们通过评估缺失数据和发病率上升对死亡率趋势的影响来重新评估这一现象。利用监测、流行病学和最终结果 (SEER) 数据，我们确定了 1973 年至 2011 年诊断为 RCC 的患者。我们使用 1983 年以来缺失数据的多重插补计算了从诊断到死亡的滞后时间，然后根据肿瘤大小估计了死亡率。在使用岭回归调整了先前的累积发病率后，无论肿瘤大小如何，都估计了死亡率。 78,891 名患者符合纳入标准。自 1983 年以来诊断的 70,212 名患者中，10.4% 存在数据缺失。当比较观察率和估算率时，从 1983 年到 2011 年，癌症特异性死亡率显着下降：Δobs0.05 与 Δimp0.10（p=0.001，<2cm 肿瘤）； Δobs0.29 与 Δimp0.18（p=0.005，2-4cm 肿瘤）； Δobs0.46 与 Δimp-0.20（p<0.001，4-7cm 肿瘤）； Δobs0.93 与 Δimp-0.15（p<0.001，>7 cm 肿瘤）。将 RCC 发病率保持在 2011 年不变的情况下，将观察到的估计值（3.9 至 6.8）与 2011 年调整后的估计值（5.9 至 7.1）进行比较时，所有患者总体死亡率的时间增长有所减弱（p<0.001），这表明发病率的快速上升可能会影响报告的总体死亡率趋势。这些发现得到了死亡率与发病率趋势评估的支持。使用肿瘤登记数据检查肾细胞癌死亡率时，数据缺失和发病率上升可能会导致“治疗脱节”现象。建议在根据这些数据做出临床和政策决策时要小心。
The paradoxical rise in overall and cancer-specific mortality despite increased detection and treatment of Renal Cell Carcinoma (RCC) is termed “treatment disconnect.” We reassess this phenomenon by evaluating impact of missing data and rising incidence on mortality trends. Using Surveillance, Epidemiology, and End Results (SEER) data, we identified patients with RCC diagnosis from 1973–2011. We estimated mortality rates by tumor size after accounting for lags from diagnosis to death using multiple imputations for missing data from 1983. Mortality rates were estimated irrespective of tumor size after adjustment for prior cumulative incidence using ridge regression. 78,891 patients met inclusion criteria. Of 70,212 patients diagnosed since 1983, 10.4% had missing data. Significant attenuation in cancer-specific mortality was noted from 1983–2011 when comparing observed to imputed rates: Δobs0.05 versus Δimp0.10 (p=0.001, <2cm tumors); Δobs0.29 versus Δimp0.18 (p=0.005, 2–4cm tumors); Δobs0.46 versus Δimp-0.20 (p<0.001, 4–7cm tumors); Δobs0.93 versus Δimp-0.15 (p<0.001, >7 cm tumors). Holding incidence of RCC constant to 2011 rates, temporal increase in overall mortality for all patients was attenuated (p<0.001) when comparing observed estimates (3.9 to 6.8) to 2011 adjusted estimates (5.9 to 7.1), suggesting that rapidly rising incidence may influence reported overall mortality trends. These findings were supported by assessment of mortality to incidence ratio trends. Missing data and rising incidence may contribute substantially to the “treatment disconnect” phenomenon when examining mortality rates in RCC using tumor registry data. Caution is advised when basing clinical and policy decisions on these data.