BACKGROUND:There is no clear consensus regarding gender differences in the prognosis of patients with clear-cell renal cell carcinoma (ccRCC). In the present study, we investigated the prognostic value of gender in patients with non-metastatic ccRCC undergoing curative surgery using the inverse probability of treatment weighting (IPTW) method to balance the difference in baseline factors between females and males. PATIENTS AND METHODS:We retrospectively reviewed the International Marker Consortium for Renal Cancer (INMARC) dataset and included 2055 patients with cT1-4N0M0 ccRCC who underwent partial or radical nephrectomy. The IPTW method was used to adjust for baseline characteristics between females and males (age, race, surgery type, and pT stage), and the association of gender with recurrence-free survival (RFS) was evaluated. RESULTS:During the follow-up (median, 30 months), 162 (8%) patients had disease recurrence (5-year RFS rate, 88%). Female gender (n = 712; 35%) was significantly associated with a lower Fuhrman grade (unweighted, P = .022; IPTW-weighted, P < .001). Females had significantly better RFS compared with males (unweighted, 5-year RFS rate, 92% vs. 87%; P = .005; IPTW-weighted, 5-year RFS rate, 92% vs. 86%; P = .002). IPTW-weighted multivariate analysis showed that female gender was an independent predictor for better RFS (hazard ratio, 0.59; P = .005) along with lower pT stage and lower Fuhrman grade. The prognostic significance of female gender was also observed in the unweighted multivariate analysis. CONCLUSION:Female gender was significantly associated with a lower Fuhrman grade and better prognosis for patients with non-metastatic ccRCC undergoing curative surgery.

译文

背景:关于透明细胞肾细胞癌(ccRCC)患者预后的性别差异尚无明确共识。在本研究中,我们使用治疗加权比的反比(IPTW)方法研究了性别在非转移性ccRCC根治性手术患者中的预后价值,以平衡男性和女性基线因素之间的差异。
病人和方法:我们回顾性地回顾了国际肾癌标志物协会(INMARC)数据集,纳入了2055例行部分或根治性肾切除术的cT1-4N0M0 ccRCC患者。 IPTW方法用于调整男女之间的基线特征(年龄,种族,手术类型和pT分期),并评估了性别与无复发生存期(RFS)的关联。
结果:在随访中(中位30个月),有162例(8%)患者复发(5年RFS率为88%)。女性性别(n = 712; 35%)与较低的Fuhrman等级显着相关(未加权,P = .022; IPTW加权,P <.001)。女性的RFS显着优于男性(未加权的5年RFS率,92%比87%; P = .005; IPTW加权的5年RFS率,92%vs. 86%; P = .002 )。 IPTW加权多变量分析表明,女性性别是更好的RFS的独立预测因子(危险比为0.59; P = .005),且pT分期和Fuhrman评分较低。在未加权的多变量分析中也观察到女性的预后意义。
结论:对于非转移性ccRCC进行根治性手术的患者,女性性别与较低的Fuhrman等级和更好的预后显着相关。

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