Trends in renal tumor surgery delivery within the United States.
Trends in renal tumor surgery delivery within the United States.
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DOI：
10.1002/cncr.24965
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发表时间：
2010-05-15
期刊：
影响因子：
6.2
通讯作者：
Huang, William C.
中科院分区：
文献类型：
--
作者：
Dulabon, Lori M.;Lowrance, William T.;Russo, Paul;Huang, William C.
关键词：
大多数小的肾肿瘤适合于肾部分切除术（PN）。研究已经证明根治性肾切除术（RN）与合并症（如慢性肾脏疾病）风险增加相关。尽管有证据表明具有等同的肿瘤学结局，但PN在美国的使用仍然不足。在这项研究中，作者确定了小肾肿瘤肾脏手术的最新趋势，并确定了哪些因素与美国PN与RN的使用相关。使用监测、流行病学和最终结果癌症登记处（SEER 1999-2006）分析基于人群的患者队列。作者确定了1999年至2006年期间在美国接受≤4 cm肾脏肿瘤手术的18，330例40至90岁患者。总共有11，870例患者（65%）接受了RN，6460例患者（35%）接受了PN。PN与RN的比例逐年增加（P <0.001），占2006年小肿瘤肾脏手术的45%。接受PN与RN的患者队列存在显著差异，包括年龄、性别、肿瘤位置、婚姻状况、治疗年份和肿瘤大小。当调整这些变量时，男性、年龄≤70岁、城市居住、较小的肿瘤大小和最近的治疗年份是PN的预测因素。尽管1999年至2006年期间美国PN手术的总数有所增加，但PN的使用仍然严重不足，特别是在妇女、老年人和居住在农村地区的人中。将需要进一步的调查，以确定这些差异的原因，并需要制定战略，以优化获得PN。
Most small renal tumors are amenable to partial nephrectomy (PN). Studies have documented the association of radical nephrectomy (RN) with an increased risk of comorbid conditions, such as chronic kidney disease. Despite evidence of equivalent oncologic outcomes, PN remains under used within the United States. In this study, the authors identified the most recent trends in kidney surgery for small renal tumors and determined which factors were associated with the use of PN versus RN within the United States. A population-based patient cohort was analyzed using the Surveillance, Epidemiology and End Results cancer registry (SEER 1999-2006). The authors identified 18,330 patients ages 40 to 90 years who underwent surgery for kidney tumors ≤4 cm in the United States between 1999 and 2006. In total, 11,870 patients (65%) underwent RN, and 6460 patients (35%) underwent PN. The ratio of PN to RN increased yearly (P < .001), representing 45% of kidney surgeries in 2006 for small tumors. There were significant differences in the cohort of patients who underwent PN versus RN, including age, sex, tumor location, marital status, year of treatment, and tumor size. When adjusting for these variables, being a man, age ≤70 years, urban residence, smaller tumor size, and more recent treatment year were predictors of PN. Although the total numbers of PN procedures increased in the United States between 1999 and 2006, there remains a significant under use of PN, particularly among women, the elderly, and those living in rural locations. Further investigation will be required to determine the reasons for these disparities, and strategies to optimize access to PN need to be developed.
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影响因子：
39.2
作者：
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通讯作者：
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