Effect of incidental detection for survival of patients with renal cell carcinoma: Results of population-based study of 701 patients
Effect of incidental detection for survival of patients with renal cell carcinoma: Results of population-based study of 701 patients
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DOI：
10.1016/j.urology.2005.07.009
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发表时间：
2005-12-01
期刊：
影响因子：
2.1
通讯作者：
Einarsson, GV
中科院分区：
文献类型：
--
作者：
Gudbjartsson, T;Thoroddsen, A;Einarsson, GV
目标。进行一项基于人群的研究，评估偶然检测出肾细胞癌 (RCC) 对生存的影响。近年来，由于腹部影像学的广泛使用，肾细胞癌的偶然发现显着增加。偶然诊断出肾细胞癌的患者生存率更高；然而，由于可能的“前置时间”偏差和阶段迁移，偶然检测对生存的真正影响一直存在争议。 1971 年至 2000 年间冰岛所有诊断为 RCC 的活着的患者均被纳入其中 (n=701)。验证组织学结果，确定疾病阶段（程度），并评估发病率、死亡率和生存率。结果。死亡率最强的预测因素是分期和核级别。在多变量分析中校正这些因素后，偶然诊断、组织学亚型和性别失去了作为死亡独立预后因素的意义。然而，偶然诊断的肿瘤平均比有症状的肿瘤小 2.3 厘米，处于较低的阶段和级别，单变量分析显示，患者的生存率明显高于有症状的肿瘤（5 年疾病特异性生存率分别为 76% 和 44%）。 RCC 发病率增加仅见于男性，但在研究期间，两性的偶然检出率均增加了三倍，因此整个群体的生存率显着提高。结论。偶然检测频率的增加提高了冰岛肾细胞癌患者的生存率。偶然检测并不是死亡的独立预后因素，表明这些肿瘤与有症状的肾细胞癌具有相似的生物学性质，只是诊断较早。
Objectives. To conduct a population-based study to evaluate the effect of incidental detection of renal cell carcinoma (RCC) on survival. Incidental detection of RCC has increased significantly in recent years because of widespread use of abdominal imaging. The patients with incidentally diagnosed RCC have better survival; however, because of possible "lead time" bias and stage migration, the real implications of incidental detection on survival have been a matter of debate.Methods. All living patients diagnosed with RCC in Iceland between 1971 and 2000 were included (n=701). The histologic findings were verified, the stage (extent) of the disease was determined, and the incidence, mortality, and survival were evaluated.Results. The strongest predictors of mortality were stage and nuclear grade. After correcting for these factors in the multivariate analysis, incidental diagnosis, histologic subtype, and gender lost their significance as independent prognostic factors of death. However, the incidentally diagnosed tumors were 2.3 cm smaller on average and at a lower stage and grade than symptomatic tumors, with significantly better patient survival than those with symptomatic tumors on univariate analysis (76% versus 44% 5-year disease-specific survival). An increased incidence of RCC was only seen in men, but incidental detection increased threefold during the study period in both sexes, with significant improvement in survival for the whole group as a result.Conclusions. The increased frequency of incidental detection has improved the survival of patients with RCC in Iceland. Incidental detection was not an independent prognostic factor of death, indicating that these tumors are of a similar biologic nature as symptomatic RCCs, only diagnosed earlier.