K Fife, C Pearson, C S Knott, A Greaves, G D Stewart
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Results were adjusted for a priori confounders, including age at diagnosis, area deprivation of residence, and Charlson Comorbidity Index. Differences in overall survival are reported.</p><p><strong>Results: </strong>The cohort comprised 18,640 tumours in 18,421 patients. Of tumours diagnosed, median patient age was 68 (interquartile range 58-77) years and 63.4% were in males. When stratified by Cancer Alliance, the proportions of T1a/T1b/N0/M0 KC that had radical nephrectomy (RN), nephron sparing surgery or ablation ranged from 53.3% (95% CI [48.7, 57.8]) to 80.3% (95% CI [73.0, 86.0]). For stage T1b-3 cancers, the proportion that received RN ranged from 65.6% (95% CI [60.3, 70.5]) to 77.3% (95% CI [72.1, 81.7]). Patients with M0 (n = 12,365) and M1 KC (n = 3312) at diagnosis had 24-month survival of 87.5% and 25.1%, respectively. Of patients diagnosed with M1 KC, 50.3% received systemic anti-cancer therapy, ranging from 39.7% (95% CI [33.7, 46.1]) to 70.7% (95% CI [59.6, 79.8]) between Cancer Alliances. The six-month survival of these patients was 77.4% compared to 27.6% for those that did not receive SACT.</p><p><strong>Conclusion: </strong>These major geographical differences in surgical and systemic therapy practice have led to national guideline development.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Variability in Kidney Cancer Treatment and Survival in England: Results of a National Cohort Study.\",\"authors\":\"K Fife, C Pearson, C S Knott, A Greaves, G D Stewart\",\"doi\":\"10.1016/j.clon.2024.08.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>To establish whether there are geographic differences in treatments and outcomes for patients with kidney cancer (KC) in England which could potentially be improved by the creation of national guidelines.</p><p><strong>Materials and methods: </strong>A multidisciplinary group convened by the charity Kidney Cancer UK developed Quality Performance Indicators (QPIs) for the treatment of KC. 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引用次数: 0
摘要
目的:确定英国肾癌(KC)患者的治疗方法和结果是否存在地域差异,并通过制定国家指南加以改进:由英国肾癌慈善机构召集的一个多学科小组制定了肾癌治疗的质量绩效指标(QPIs)。对2017年至2018年期间在英格兰确诊的所有组织学诊断为KC的患者遵守这些QPIs的情况进行了报告。利用从国家数据集中提取的数据,采用逻辑和线性概率模型来估算癌症联盟和 NHS 信托基金各级手术和全身抗癌治疗实施的地域差异。结果已根据先验混杂因素(包括诊断时的年龄、居住地贫困程度和夏尔森综合指数)进行调整。报告了总生存率的差异:研究对象包括18,421名患者的18,640个肿瘤。在确诊的肿瘤患者中,中位年龄为68岁(四分位数间距为58-77岁),63.4%为男性。根据癌症联盟进行分层后,T1a/T1b/N0/M0 KC 中接受根治性肾切除术 (RN)、肾小球保留手术或消融术的比例从 53.3% (95% CI [48.7, 57.8])到 80.3% (95% CI [73.0, 86.0])不等。对于T1b-3期癌症,接受RN治疗的比例从65.6%(95% CI [60.3,70.5])到77.3%(95% CI [72.1,81.7])不等。确诊时为M0(n = 12365)和M1 KC(n = 3312)的患者的24个月生存率分别为87.5%和25.1%。在确诊为M1 KC的患者中,50.3%接受了全身抗癌治疗,癌症联盟之间的比例从39.7%(95% CI [33.7,46.1])到70.7%(95% CI [59.6,79.8])不等。这些患者的 6 个月生存率为 77.4%,而未接受 SACT 的患者的 6 个月生存率为 27.6%:结论:手术和系统治疗实践中存在的这些重大地域差异促成了国家指南的制定。
Variability in Kidney Cancer Treatment and Survival in England: Results of a National Cohort Study.
Aims: To establish whether there are geographic differences in treatments and outcomes for patients with kidney cancer (KC) in England which could potentially be improved by the creation of national guidelines.
Materials and methods: A multidisciplinary group convened by the charity Kidney Cancer UK developed Quality Performance Indicators (QPIs) for the treatment of KC. Adherence to these QPIs was reported for all patients with a histological diagnosis of KC diagnosed in England between 2017 and 2018. Utilising data extracted from national datasets, logistic and linear probability models were used to estimate geographic variation in the delivery of surgery and systemic anti-cancer therapy at Cancer Alliance and NHS trust levels. Results were adjusted for a priori confounders, including age at diagnosis, area deprivation of residence, and Charlson Comorbidity Index. Differences in overall survival are reported.
Results: The cohort comprised 18,640 tumours in 18,421 patients. Of tumours diagnosed, median patient age was 68 (interquartile range 58-77) years and 63.4% were in males. When stratified by Cancer Alliance, the proportions of T1a/T1b/N0/M0 KC that had radical nephrectomy (RN), nephron sparing surgery or ablation ranged from 53.3% (95% CI [48.7, 57.8]) to 80.3% (95% CI [73.0, 86.0]). For stage T1b-3 cancers, the proportion that received RN ranged from 65.6% (95% CI [60.3, 70.5]) to 77.3% (95% CI [72.1, 81.7]). Patients with M0 (n = 12,365) and M1 KC (n = 3312) at diagnosis had 24-month survival of 87.5% and 25.1%, respectively. Of patients diagnosed with M1 KC, 50.3% received systemic anti-cancer therapy, ranging from 39.7% (95% CI [33.7, 46.1]) to 70.7% (95% CI [59.6, 79.8]) between Cancer Alliances. The six-month survival of these patients was 77.4% compared to 27.6% for those that did not receive SACT.
Conclusion: These major geographical differences in surgical and systemic therapy practice have led to national guideline development.
期刊介绍:
Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.