Partial nephrectomy for small renal masses: An emerging quality of care concern?
Partial nephrectomy for small renal masses: An emerging quality of care concern?
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DOI：
10.1016/s0022-5347(05)00422-2
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发表时间：
2006-03-01
影响因子：
6.6
通讯作者：
Hollenbeck, BK
中科院分区：
文献类型：
--
作者：
Miller, DC;Hollingsworth, JM;Hollenbeck, BK
目的：腹腔镜自由基肾切除术的最新普及可能不足以部分肾切除术。为了评估这种关注点，我们使用SEER注册中心来表征针对小肾脏肿块手术管理的国家实践模式。材料和方法：1988年至2001年之间，在14,647例原发性肿瘤尺寸7 cm或更少的患者中接受了手术治疗的遗传性肾脏癌。通过诊断和肿瘤大小的年份确定了用PN治疗的患者的比例。开发了多变量模型，以鉴定肾癌手术治疗后PN使用的独立决定因素。分析：总体1,401例患者（9.6％）用PN vs 13,246（90.4％）接受了接受总肾切除术的患者。对于7厘米或更少的肿瘤，PN的使用在1988年（4.6％）和2001年之间逐渐增加（17.6％，p <0.001）。尽管这种趋势，即使对于最小的肾脏肿块，PN仍然很少见。在肿瘤小于2 cm的患者中，1988年至1989年的PN和2000年至2001年的42％接受了PN。对于2至4 cm的肿瘤，相应比例分别为5％和20％（p <0.001）。年轻的患者年龄，较小的肿瘤大小和近期诊断年是PN使用的独立决定因素（所有P值<0.05）。对于用PN VS VS TN治疗的患者（HR 0.9，95％CI 0.8-1.1）的所有原因都是相似的。结论：尽管在过去的20年中使用了更频繁的应用，但全国范围内的PN使用PN仍然相对罕见，即使对于最小的肾脏质量也相对罕见。认识到与保存肾实质相关的有利结果，我们的发现确定了泌尿外科社区应解决的可能的护理问题。
Purpose: The recent popularization of laparoscopic radical nephrectomy may beget underuse of partial nephrectomy. To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses.Materials and Methods: Between 1988 and 2001, 14,647 patients with primary tumor size 7 cm or less were treated surgically for locoregional kidney cancer. The proportion of patients treated with PN was determined and stratified by year of diagnosis and tumor size. Multivariate models were developed to identify independent determinants of PN use and overall survival following surgical treatment of kidney cancer.Results: Overall 1,401 patients (9.6%) were treated with PN vs 13,246 (90.4%) who underwent total nephrectomy. For tumors 7 cm or less, the use of PN increased progressively between 1988 (4.6%) and 2001 (17.6%, p < 0.001). Despite this trend PN remained fairly uncommon even for the smallest renal masses. Among patients with tumors less than 2 cm, 14% underwent PN in 1988 to 1989 vs 42% in 2000 to 2001. For tumors 2 to 4 cm the corresponding proportions were 5% and 20%, respectively (p < 0.001). Younger patient age, smaller tumor size and more recent diagnostic year were independent determinants of PN use (all p values < 0.05). All cause mortality was similar for patients treated with PN vs TN (HR 0.9, 95% CI 0.8-1.1).Conclusions: Despite more frequent application during the last 2 decades, nationwide use of PN remains relatively uncommon, even for the smallest renal masses. Recognizing the favorable outcomes associated with preservation of renal parenchyma, our findings identify a possible quality of care concern that should be addressed by the urological community.