Trends and variations in utilization of nephron-sparing procedures for stage I kidney cancer in the United States.
Trends and variations in utilization of nephron-sparing procedures for stage I kidney cancer in the United States.
复制标题
美国 I 期肾癌保留肾单位手术的使用趋势和变化。
DOI：
10.1007/s00345-012-0873-6
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发表时间：
2013
影响因子：
3.4
通讯作者：
Galsky,MatthewD
中科院分区：
文献类型：
--
作者：
Small,AlexanderC;Tsao,Che-Kai;Moshier,ErinL;Gartrell,BenjaminA;Wisnivesky,JuanP;Godbold,James;Sonpavde,Guru;Palese,MichaelA;Hall,SimonJ;Oh,WilliamK;Galsky,MatthewD
在美国，早期肾脏肿瘤的偶然发现正在增加。保留肾单位的方法（NS）来管理这些肿瘤是等同于根治性肾切除术（RN）的肿瘤学结果，并有肾功能的影响减少。我们的目的是评估在过去十年中使用NS的趋势和社会经济因素与其use.MethodsThe国家癌症数据库查询，以确定2000年和2008年之间的I期肾癌患者。根据手术类型将患者分为NS（局部破坏和局部切除）或RN。患者进一步按年龄、种族、保险状况和收入分类。对数二项回归估计患病率（PR）的比例NS RN根据人口和社会经济特征。ResultsFrom 2000 to 2008，有142,194例肾癌报告给NCDB。在这些病例中，43，034例（30.3%）患者患有NS，86，431例（60.78%）患者患有RN。NS的患病率每年增加10%（PR = 1.10，p < 0.0001）-从2000年的20.0%增加到2008年的45.1%。年龄较大，收入较低，黑人种族，西班牙裔，和缺乏健康保险与NS的患病率下降。ConclusionsNS作为治疗I期肾癌自2000年以来稳步增加。年龄、种族和社会经济差异可能存在于NS的使用中。需要使用患者水平数据进行额外分析，以解决这些变量的独立意义，从而制定缓解这些潜在差异的策略。
PurposeThe incidental detection of early-stage kidney tumors is increasing in the United States. Nephron-sparing approaches (NS) to managing these tumors are equivalent to radical nephrectomy (RN) in oncologic outcomes and have a decreased impact on renal function. Our objective was to evaluate trends in the use of NS over the past decade and the socioeconomic factors associated with its use.MethodsThe National Cancer Database was queried to identify patients with stage I kidney cancer between 2000 and 2008. Patients were classified by the type of surgery as NS (local destruction and local excision) or RN. Patients were further categorized by age, race, insurance status, and income. Log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of NS to RN according to demographic and socioeconomic characteristics.ResultsFrom 2000 to 2008, there were 142,194 cases of kidney cancer reported to the NCDB. In these cases, 43,034 (30.3 %) patients had NS, and 86,431 (60.78 %) patients had RN. The prevalence of NS increased 10 % per year (PR = 1.10,p< 0.0001)—from 20.0 % in 2000 to 45.1 % in 2008. Older age, lower income, Black race, Hispanic ethnicity, and lack of health insurance were associated with a decreased prevalence of NS.ConclusionsNS as a treatment for stage I kidney cancer has increased steadily since 2000. Age, racial, and socioeconomic differences may exist in the utilization of NS. Additional analyses, with patient level data, are required to address the independent significance of these variables in an effort to develop strategies to mitigate these potential disparities.