Population-based Assessment of Survival After Cytoreductive Nephrectomy Versus No Surgery in Patients With Metastatic Renal Cell Carcinoma
Population-based Assessment of Survival After Cytoreductive Nephrectomy Versus No Surgery in Patients With Metastatic Renal Cell Carcinoma
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DOI：
10.1016/j.urology.2008.09.022
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发表时间：
2009-02-01
期刊：
影响因子：
2.1
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
--
作者：
Zini, Laurent;Capitanio, Umberto;Karakiewicz, Pierre I.
目的研究以人群为基础的生存率与细胞减少性肾切除术（CNT）治疗的转移性肾细胞癌（RCC）患者，并将其与那些未经手术治疗的患者进行比较。方法在1988-2004年监测，流行病学和最终结果数据库中确定的43143例RCC患者中，5372例转移性RCC。其中，2447例接受CNT治疗（45.5%），2925例（54.5%）未接受CNT治疗。使用了无变量和多变量考克斯回归模型，以及匹配和非匹配Kaplan-Meier生存分析。结果CNT治疗组1、2、5、10年总生存率分别为53.6%、36.3%、19.4%、12.7%，而非手术组分别为18.5%、7.4%、2.3%、1.2%。相应的癌症特异性生存率分别为58.1%、40.8%、24.3%和18.8%;相同患者组分别为24.4%、11.0%、4.1%和2.9%。在多变量分析中，独立的预测因素包括治疗类型、肿瘤大小和患者年龄（均P <0.001）。此外，相对于CNT，非手术组的总体死亡率和癌症特异性死亡率高2.5倍（P <0.001）。在配对分析中，几乎相同的效果记录（风险比2.6，P <0.001）。结论我们的研究结果表明，CNT显着提高转移性RCC患者的生存。泌尿学73：342-346，2009年。(C)2009年由Elsevier Inc.出版
OBJECTIVES To examine the population-based survival rates of patients with metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy (CNT) and compare them with those of patients treated without surgery.METHODS Of the 43 143 patients with RCC identified in the 1988-2004 Surveillance, Epidemiology, and End Results database, 5372 had metastatic RCC. Of those, 2447 were treated with CNT (45.5%) and 2925 (54.5%) were not. Unvariable and multivariable Cox regression models, as well as matched and unmatched Kaplan-Meier survival analyses, were used. The covariates consisted of age, sex, tumor size, and year of diagnosis.RESULTS The 1-, 2-, 5-, and 10-year overall Survival rate of the patients treated with CNT was 53.6%, 36.3%, 19.4%, and 12.7% compared with 18.5%, 7.4%, 2.3%, and 1.2% for the no-surgery patients, respectively. The corresponding cancer-specific survival rates were 58.1%, 40.8%, 24.3%, and 18.8% and 24.4%, 11.0%, 4.1%, and 2.9% for the same patient groups. On multivariate analysis, independent predictor status was recorded for treatment type, tumor size, and patient age (all P < .001). Also, relative to CNT, the no-surgery group had a 2.5-fold greater rate of overall and cancer-specific mortality (P < .001). In the matched analyses, virtually the same effect was recorded (hazard ratio 2.6, P < .001).CONCLUSION The results of our study have shown that CNT significantly improves the survival of patients with metastatic RCC. UROLOGY 73: 342-346, 2009. (C) 2009 Published by Elsevier Inc.