Better survival in patients with metastasised kidney cancer after nephrectomy: A population-based study in the Netherlands
Better survival in patients with metastasised kidney cancer after nephrectomy: A population-based study in the Netherlands
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DOI：
10.1016/j.ejca.2011.03.002
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发表时间：
2011-09-01
影响因子：
8.4
通讯作者：
van Spronsen, D. J.
中科院分区：
文献类型：
--
作者：
Aben, K. K. H.;Heskamp, S.;van Spronsen, D. J.
目的：细胞减少性肾切除术被认为对转移性肾癌患者是有益的，但这些患者中只有一小部分患者接受了细胞减少性手术。本研究评估了肾切除的相关因素和肾切除对生存的独立影响。方法：从基于人群的肿瘤登记中选择患者，并从临床档案中检索详细的数据。用Logistic回归分析评估与肾切除相关的因素。COX比例风险回归分析评估与生存相关的因素；纳入反映接受手术治疗概率的倾向评分，以调整混杂因素。结果：1999年至2005年诊断的328例转移性肾癌患者中，37.5%的患者接受了肾切除术。表现评分低、年龄高、合并2个转移、低或高BMI、体重减轻、乳酸脱氢酶升高、碱性磷酸酶升高、女性和肝脏或骨转移的患者不太可能接受手术治疗。接受和不接受肾切除的患者三年生存率分别为25%和4%(p<；0.001)。在调整了包括倾向评分在内的其他预后因素后，肾切除仍然与更好的生存显著相关(风险比：0.52，95%可信区间：0.37-0.73)。结论：即使在考虑了预后因素后，患者仍然受益于肾切除；观察到死亡率下降了约50%。因此，建议转移性疾病的患者在没有禁忌症的情况下接受细胞减少术。细胞减灭术与靶向分子疗法相结合的试验结果正在等待中。(C)2011爱思唯尔有限公司。保留所有权利。
Aim: Cytoreductive nephrectomy is considered beneficial in patients with metastasised kidney cancer but only a minority of these patients undergo cytoreductive surgery. Factors associated with nephrectomy and the independent effect of nephrectomy on survival were evaluated in this study.Methods: Patients were selected from the population-based cancer registry and detailed data were retrieved from clinical files. Factors associated with nephrectomy were evaluated by logistic regression analyses. Cox proportional hazard regression analysis was performed to evaluate factors associated with survival; a propensity score reflecting the probability of being treated surgically was included in order to adjust for confounding by indication.Results: 37.5% of 328 patients diagnosed with metastatic kidney cancer between 1999 and 2005 underwent nephrectomy. Patients with a low performance score, high age, >= 2 comorbid conditions, >= 2 metastases, low or high BMI, weight loss, elevated lactate dehydrogenase, elevated alkaline phosphatase, female gender and liver or bone metastases were less likely to be treated surgically. Three year survival was 25% and 4% for patients with and without nephrectomy, respectively (p < 0.001). After adjustment for other prognostic factors including the propensity score, nephrectomy remained significantly associated with better survival (Hazard ratio: 0.52, 95% Confidence interval: 0.37-0.73).Conclusions: Even after accounting for prognostic profile, patients still benefit from a nephrectomy; an approximately 50% reduction in mortality was observed. It is, therefore, recommended that patients with metastasised disease receive cytoreductive surgery when there is no contraindication. Trial results on cytoreductive surgery combined with targeted molecular therapeutics are awaited for. (C) 2011 Elsevier Ltd. All rights reserved.