肾细胞癌是起源于肾实质泌尿小管上皮系统的恶性肿瘤,简称肾癌,占肾恶性肿瘤的80%~90%,是我国十大恶性肿瘤之一。其中约20%~30%的肾癌在确诊时已发生转移,常见的转移器官为肺、骨、脑、肝脏等,发生转移的肾癌患者预后较差,生存期较短。
研究摘要 755 Trends of metastasectomy for metastatic renal cell carcinoma and their impact on overall survival Introduction & Objectives: The treatment of metastatic renal cell carcinoma (mRCC) has profoundly changed over the last decade. There is little comprehensive evidence evaluating the role of metastasectomy (MSx) in in this context. We assessed trends and predictors of MSx and their impact on overall survival in a large national cohort. Material & Methods: The National Cancer Data Base from 1998-2012 was queried to identify 25455 mRCC patients with 5315 undergoing MSx. Covariates included the application of targeted chemotherapy (CTX) and immunotherapy (ITX). Baseline descriptive and multivariable logistic regression analyses for prediction of MSx were conducted. Trends for chemo- (CTX) and immunotherapy (ITX) as well as MSx were assessed using the annual percent change linear regression technique (EAPC). Kaplan-Meier curves and adjusted Cox-proportional hazard models assessed the impact of MSx on overall survival. Results: Compared to controls, MSx patients were significantly younger (p<0.001), had="" a="" lower="" cci="" (p="0.03)," more="" often="" private="" insurance="" (p="0.04)" and="" a="" higher="" income="">0.001),><0.001). they="" were="" more="" often="" treated="" at="" an="" academic="" center="">0.001).><0.001), but="" less="" often="" received="" itx/ctx="" (both="">0.001),><0.001). the="" rates="" of="" msx="" increased="" significantly="" over="" the="" years="" (9.9-24.5%,="" eapc="" 4.52,="">0.001).><0.001) while="" ctx="" (eapc="" 3.08,="">0.001)><0.001) increased="" and="" itx="" decreased="" (eapc="" -12.9,="">0.001)><0.001). diagnosis="" after="" 2006="" (or="" 1.21,="" 95%ci="" 1.02-1.23)="" and="" private="" insurance="" (or="" 1.43,="" 95%="" ci="" 1.14-1.79)="" were="" positive="" predictors="" of="" msx,="" whereas="" increasing="" age="" (or="" 0.98,="" 95%ci="" 0.98-0.99),="" black="" race="" (or="" 0.73,="" 95%ci="" 0.63-0.84),="" itx="" (or="" 0.8,="" 95%ci="" 0.68-0.94)="" and="" ctx="" (or="" 0.75,="" 95%="" 0.69-0.82)="" were="" negatively="" associated="" with="" msx.="" the="" combined="" treatment="" with="" msx="" conferred="" a="" survival="" benefit="" compared="" to="" no="" msx="" (hr="" 0.75,="" 95%ci="" 0.72-0.78)="" and="" ctx="" alone="" (hr="" 0.82,="" 95%ci="">0.001).> Conclusions: The addition of MSx to CTX conferred a survival benefit in our study despite lower usage of MSx after CTX. This suggests a potential underutilization, which might be a consequence of underlying health care access disparities as implied by lower odds of receiving MSx in blacks and higher odds in privately insured patients. (来源:《肿瘤瞭望》编辑部) |
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