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Abstract：
OBJECTIVE: To examine associations between ablative therapy (AT) and partial nephrectomy (PN) and the occurrence of local recurrence (LR), distant metastatic recurrence (DMR) and all-cause mortality in a nation-wide real-world population-based cohort of patients with nonmetastatic renal cell carcinoma (nmRCC).
METHODS: Data on 2751 AT- or PN-treated nmRCC tumours diagnosed during 2005-2018, representing 2701 unique patients, were obtained from the National Swedish Kidney Cancer Register. Time to LR/DMR or death with/without LR/DMR was analysed using Cox regression models.
RESULTS: During a mean of 4.8 years follow-up, LR was observed for 111 (4.0%) tumours, DMR for 108 (3.9%) tumours, and death without LR/DMR for 206 (7.5%) tumours. AT-treated tumours had a 4.31 times higher risk of LR (P < 0.001) and a 1.91 times higher risk of DMR (P = 0.018) than PN-treated, with no significant differences in risk of death without LR/DMR. During a mean of 3.2 and 2.5 years of follow-up after LR/DMR, respectively, 24 (21.6%) of the LR cases and 56 (51.9%) of the DMR cases died, compared to 7.5% in patients without LR/DMR. There were no significant differences between AT- and PN-treated regarding risks of early death after occurrence of LR or DMR.
CONCLUSIONS: AT treatment of patients with nmRCC implied significantly higher risks of LR and DMR compared with PN treatment. To minimize the risks of LR and DMR, these results suggest that PN is preferred over AT as primary treatment, supporting the EAU guidelines to recommended AT mainly to frail and/or comorbid patients.
METHODS: Data on 2751 AT- or PN-treated nmRCC tumours diagnosed during 2005-2018, representing 2701 unique patients, were obtained from the National Swedish Kidney Cancer Register. Time to LR/DMR or death with/without LR/DMR was analysed using Cox regression models.
RESULTS: During a mean of 4.8 years follow-up, LR was observed for 111 (4.0%) tumours, DMR for 108 (3.9%) tumours, and death without LR/DMR for 206 (7.5%) tumours. AT-treated tumours had a 4.31 times higher risk of LR (P < 0.001) and a 1.91 times higher risk of DMR (P = 0.018) than PN-treated, with no significant differences in risk of death without LR/DMR. During a mean of 3.2 and 2.5 years of follow-up after LR/DMR, respectively, 24 (21.6%) of the LR cases and 56 (51.9%) of the DMR cases died, compared to 7.5% in patients without LR/DMR. There were no significant differences between AT- and PN-treated regarding risks of early death after occurrence of LR or DMR.
CONCLUSIONS: AT treatment of patients with nmRCC implied significantly higher risks of LR and DMR compared with PN treatment. To minimize the risks of LR and DMR, these results suggest that PN is preferred over AT as primary treatment, supporting the EAU guidelines to recommended AT mainly to frail and/or comorbid patients.
摘要：
目的：探讨肾部分切除术（PN）与局部复发（LR）的相关性，非转移性肾细胞癌(nmRCC)患者的以人群为基础的全国性真实世界队列研究中的远处转移性复发(DMR)和全因死亡率.
方法：在2005-2018年期间诊断出的2751例AT或PN治疗的nmRCC肿瘤的数据，代表2701例独特患者，是从瑞典国家肾癌登记册获得的。使用Cox回归模型分析LR/DMR或有/无LR/DMR的死亡时间。
结果：在平均4.8年的随访中，观察到111例(4.0%)肿瘤的LR，108例（3.9%）肿瘤的DMR，206例（7.5%）肿瘤无LR/DMR死亡。与PN治疗相比，AT治疗的肿瘤发生LR的风险高4.31倍（P<0.001），DMR的风险高1.91倍（P=0.018），无LR/DMR的死亡风险无显著差异。在LR/DMR后平均3.2年和2.5年的随访中，分别,24例(21.6%)LR病例和56例(51.9%)DMR病例死亡,与无LR/DMR患者的7.5%相比。在LR或DMR发生后早期死亡的风险方面，AT和PN治疗之间没有显着差异。
结论：AT治疗nmRCC患者意味着LR和DMR的风险明显高于PN治疗。为了将LR和DMR的风险降至最低，这些结果表明，PN优先于AT作为主要治疗，支持EAU指南，主要向虚弱和/或合并症患者推荐AT。
方法：在2005-2018年期间诊断出的2751例AT或PN治疗的nmRCC肿瘤的数据，代表2701例独特患者，是从瑞典国家肾癌登记册获得的。使用Cox回归模型分析LR/DMR或有/无LR/DMR的死亡时间。
结果：在平均4.8年的随访中，观察到111例(4.0%)肿瘤的LR，108例（3.9%）肿瘤的DMR，206例（7.5%）肿瘤无LR/DMR死亡。与PN治疗相比，AT治疗的肿瘤发生LR的风险高4.31倍（P<0.001），DMR的风险高1.91倍（P=0.018），无LR/DMR的死亡风险无显著差异。在LR/DMR后平均3.2年和2.5年的随访中，分别,24例(21.6%)LR病例和56例(51.9%)DMR病例死亡,与无LR/DMR患者的7.5%相比。在LR或DMR发生后早期死亡的风险方面，AT和PN治疗之间没有显着差异。
结论：AT治疗nmRCC患者意味着LR和DMR的风险明显高于PN治疗。为了将LR和DMR的风险降至最低，这些结果表明，PN优先于AT作为主要治疗，支持EAU指南，主要向虚弱和/或合并症患者推荐AT。
