Cytoreductive nephrectomy in the modern era: Predictors of use, morbidity, and survival

Author:

Minnillo Brian J.,Tabayoyong William,Francis John J.,Maurice Matthew J.,Zhu Hui,Kim Simon,Abouassaly Robert

Abstract

Introduction: To determine tumour, patient, and provider factors associated with cytoreductive nephrectomy (CN) use and to identify those factors that predicted short-term and long-term surgical outcomes.Methods: We performed a retrospective review (1998‒2011) of the National Cancer Database, a U.S. population-based oncology outcomes database. The review included 36 549 patients with metastatic renal cell carcinoma (mRCC). We assessed predictors of CN use, length of stay (LOS), 30-day readmission, and 30-day mortality using multivariable logistic regression. The Cox proportional hazards model assessed predictors of overall survival (OS).Results: Overall, 10 809 (29.6%) patients received CN, increasing from 15.2% to 36.1% over time. Private insurance (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.16‒1.37) and academic facilities (OR 1.83; 95% CI 1.68‒1.99) were associated with receiving CN (p<0.0001). Charlson score ≥2 and older age group were less likely to undergo surgery (p<0.0001). Median LOS was five days (interquartile range [IQR] 3‒7), while 30-day readmission and 30-day mortality were 5.3% and 3.3%, respectively. Undergoing CN (hazard ratio [HR] 0.48; 95% CI 0.44‒0.52; p<0.0001) and treatment at academic centres (HR 0.88; 95% CI 0.81‒0.95; p=0.001) were independently associated with improved OS. Limitation includes retrospective design with possible selection bias.Conclusions: Increased CN use continues in the modern era, with relatively low surgical morbidity. Further study is required to determine if the finding of lower all-cause mortality in patients treated at academic centres is due to improved care or unmeasured confounders.

Publisher

Canadian Urological Association Journal

Subject

Urology,Oncology

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3