World J Urol:婚姻状况和性别会影响肾癌治疗疗效,丧偶、离异/分居的男性尤甚!

2017-09-18 Ryy 肿瘤资讯

一项来自加拿大、意大利及德国的研究表明,婚姻状况及性别会影响肾细胞癌(RCC)患者的治疗选择,丧偶、离异/分居的男性治疗后预后更差。研究纳入约57700例T1-T2, N0, M0 RCC患者,结果显示丧偶、离异/分居的男性非手术治疗性更高、罹患T2分期、G3/G4风险更大,癌症特异性死亡率增高。

一项来自加拿大、意大利及德国的研究表明,婚姻状况及性别会影响肾细胞癌(RCC)患者的治疗选择,丧偶、离异/分居的男性治疗后预后更差。研究纳入约57700例T1-T2, N0, M0 RCC患者,结果显示丧偶、离异/分居的男性非手术治疗性更高、罹患T2分期、G3/G4风险更大,癌症特异性死亡率增高。

背景

丧偶、离异、独居及未婚状态等是多种泌尿生殖系统恶性肿瘤如前列腺癌、膀胱癌等的不良预后因素,对于非泌尿生殖系肿瘤也是如此。但是,目前没有研究数据证实,婚姻状况及性别对局部非转移性RCC患者的分期、肿瘤分级、治疗类型及癌症特异性死亡率(CSM)产生影响。为解决这一问题,研究人员综合性分析了当代人群队列,假设性别及婚姻状况会对以上因素产生影响。

方法

数据来源及研究人群:SEER数据库中T1–2 N0 M0 RCC患者。目标人群为年龄≥18岁的肾实质肿瘤,病理证实的RCC。

病理类型包括:透明细胞RCC (ccRCC)、乳头状癌,嫌色细胞癌,肉瘤样癌,囊肿相关的RCC,集合管癌等。乳头状癌及嫌色细胞癌统一归纳为非ccRCC。肉瘤样癌,囊肿相关的RCC,集合管癌等统一归纳为“其他”。

结果

描述性分析及时间趋势

共筛选出57700例T1–2 N0 M0 RCC患者。平均确诊年龄为61岁(范围 52-73岁)。大部分已婚(65.8%),男性占61.8%,白人占81.9%,高收入人群占(SES)52.4%。绝大部分为T1 期 (84.9%),G1/G2 级(73.7%),病理类型为ccRCC (62.6%)。94.9%的患者接受了手术治疗。丧偶占8.8%,离异/分居占10.6%,未婚占14.8%。三种婚姻状况所占比例,男性中分别为3.9%, 9.0% 及14.9%;女性分别为16.7%、13.1%和14.7%。

时间趋势分析(2001-2013),男性离异/分居的比例由5.4%上升至9.7%(APC +2.5%, CI 1.1–3.9, p = 0.005),未婚的比例由12.8%上升至16.1%(APC +2.5%, CI 2.0–2.9, p < 0.001),丧偶的比例比较稳定,从3.9%下降至2.6%(APC ?1.3%, CI ?2.9 至0.4, p = 0.2);女性各种类型婚姻状况的比例均无明显变化,离异/分居的比例由11.0%上升至13.7% (APC 0.6%, CI ?0.6 to 1.8, p = 0.4),未婚的比例由12.9%上升至17.8% (APC 2.3%, CI ?0.1至4.7, p = 0.08),丧偶的比例从17.8 下降至 13.8% (APC ?1.4%, CI ?2.8至 0.1, p = 0.1)。

婚姻状况和性别对分期、分级和治疗类型的影响

多变量预测病理T2 vs. T1分期,婚姻状态中仅有未婚对ccRCC的疾病分期有影响(OR 1.11, CI 1.02–1.21; p = 0.02)。对于整体研究队列(OR 1.12, CI 1.07–1.18; p < 0.001)及ccRCC亚组(OR 1.14, CI 1.07–1.21; p < 0.001),男性罹患T2风险增加。多变量预测肿瘤分级G3/G4 vs. G1/G2,婚姻状态不增加G3/G4风险。对于整体研究队列(OR 1.35, CI 1.30–1.41; p < 0.001)及ccRCC亚组(OR 1.48, CI 1.40–1.55; p < 0.001),男性罹患G3/G4风险增加。

多变量预测治疗类型,非手术vs.手术,丧偶(OR 1.13, CI 1.00–1.28; p = 0.04)、离异/分居(OR 1.16, CI 1.02–1.32; p = 0.02)及未婚(OR 1.38, CI 1.23–1.54; p < 0.001)增加非手术治疗风险。但是对于ccRCC亚组,只有未婚会增加非手术治疗风险(OR 1.24, CI 1.08–1.44; p < 0.001)。无论是对整体研究队列(1.23, CI 1.13–1.33; p < 0.001))还是ccRCC亚组(1.17, CI 1.06–1.29; p = 0.002),男性都是非手术治疗风险增加的因素。

综合分析显示,未婚预示着T2 分期发生率(OR 1.05, p = 0.07)、G3/G4(OR 1.00, p = 0.8)及非手术治疗(OR 1.23, p < 0.001)风险增加,对于ccRCC亚组,T2 分期(OR 1.07, p = 0.04)、G3/G4(OR 0.99, p = 0.9)及非手术治疗(OR 1.16, p = 0.004)结果与总体队列结果一致。

婚姻状况和性别对CSM的影响

在研究期间,共有6062例死亡,62.8%为其他原因死亡(OCM)。ccRCC共3572例死亡,63.1%为OCM。多因素CRR模型分析,丧偶(HR 1.32, CI 1.15–1.52; p < 0.001)、离异/分居(HR 1.32, CI 1.15–1.51; p < 0.001)、男性(HR 1.13, CI 1.03–1.23; p = 0.01)与较高CSM相关,但未婚状态与其无关(HR 1.12, CI 0.98–1.28; p = 0.09)。此外,T2分期(HR 3.46, CI 3.17–3.77; p < 0.001)、G3/G4(HR 2.02, CI 1.85–2.20; p < 0.001)及非手术治疗(HR 1.48, CI 1.22–1.81; p < 0.001)也与较高CSM相关。ccRCC亚组分析结果与总体队列一致。

结论

男性患者具有更高的风险,且基线特征较为不利。男性、丧偶、离异/分居T1–2 N0 M0 RCC患者治疗后预后较差。这些结果表明,局部RCC治疗后需更多关注具有上述特征的患者。

述评

这项研究的结果表明,婚姻状态及性别会影响RCC患者的治疗选择。丧偶、分居或离异的男性,预后更差。研究者有以下重要发现:1丧偶、分居、离异或从未结过婚的患者,有较高的非手术治疗风险;2透明细胞RCC亚组中,未婚的患者表现出更高的T2与T1期癌症的比率。然而,在整个队列中,丧偶、分居、离婚或未婚并没有增加T分期和肿瘤分级的风险;3丧偶或分居/离婚会增加CSM风险;4男性具有较高的非手术治疗、较高T分期、较高肿瘤分级及CSM增加的风险。

主要研究者Marchioni教授表示,他们的研究提示,临床医生应更多关注患者的婚姻状况,特别是那些局限性RCC治疗后丧偶、分居/离异的男性患者。

点评

通过SEER数据库中RCC患者的研究,可以看到性别及婚姻状况对于疾病治疗、分期、分级甚至预后具有重要影响。通常我们根据患者病理类型、癌症分期判断患者的预后,但现实中,具有相同病理类型、相同分期的患者的预后并不一致,原因为何?这项研究提示我们,患者的一些人口学特征会影响预后,比如性别等等。

这是一篇回顾性研究,结果可供临床参考,但同时也要考虑到研究本身的局限性。比如男性患者CSM风险较高,但是男性的平均寿命本身较女性短。因此,男性是否可以作为RCC患者预后不良的预测因素还需要进一步验证。

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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-20 lietome24

    感谢小编为我们准备了如此丰盛的精神大餐.同时也向作者致谢!认真学习了.点赞!

    0

  3. 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time=2017-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245336, encodeId=521a24533696, content=阅读了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Mon Sep 18 13:46:25 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245313, encodeId=3c4d245313d8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Mon Sep 18 11:30:07 CST 2017, time=2017-09-18, status=1, ipAttribution=), 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 18 07:47:49 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245217, encodeId=253e24521ea3, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon Sep 18 07:02:16 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245204, encodeId=219824520486, content=学了.........., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-19 尹玉伟

    厉害厉害--学习了

    0

  4. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-19 lofter

    学习了感谢分享

    0

  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-18 半夏微凉

    阅读了谢谢分享

    0

  6. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-18 yfjms

    学习了

    0

  7. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-18 有备才能无患

    丧偶.离异.独居及未婚状态等是多种泌尿生殖系统恶性肿瘤如前列腺癌.膀胱癌等的不良预后因素.对于非泌尿生殖系肿瘤也是如此

    0

  8. 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time=2017-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245336, encodeId=521a24533696, content=阅读了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Mon Sep 18 13:46:25 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245313, encodeId=3c4d245313d8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Mon Sep 18 11:30:07 CST 2017, time=2017-09-18, status=1, ipAttribution=), 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 18 07:47:49 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245217, encodeId=253e24521ea3, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon Sep 18 07:02:16 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245204, encodeId=219824520486, content=学了.........., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-18 李东泽

    很好.学习了.很有帮助.

    0

  9. 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time=2017-09-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245336, encodeId=521a24533696, content=阅读了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Mon Sep 18 13:46:25 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245313, encodeId=3c4d245313d8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Mon Sep 18 11:30:07 CST 2017, time=2017-09-18, status=1, ipAttribution=), 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 18 07:47:49 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245217, encodeId=253e24521ea3, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Mon Sep 18 07:02:16 CST 2017, time=2017-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=245204, encodeId=219824520486, content=学了.........., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Mon Sep 18 06:49:02 CST 2017, time=2017-09-18, status=1, ipAttribution=)]
    2017-09-18 明月清辉

    谢谢分享.学习了

    0

  10. 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    2017-09-18 135****7952平儿

    学了..........

    0

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