目前尚不清楚在 2018 年发表 Cancer du Rein Métastatique Nephretomie et Antiangiogéniques (CARMENA) 试验后，美国的细胞减灭术 (CN) 实践是否发生了变化。我们的主要目标是确定 CARMENA 试验对 CN 率的影​​响美国。从 2004 年至 2020 年，在国家癌症数据库中确定了患者。使用准实验双重差分分析来测试主要结果，如下：评估转移性透明细胞肾细胞癌（ ccRCC）患者在 2018 年之前与之后诊断，同时使用在非转移性 ccRCC 情况下进行的局部肾切除术 (LN) 率作为对照组。双重差分分析发现 CARMENA 后 CN 率有统计学显着性下降（β-系数[标准误差]：-0.06 [0.025]，p = 0.028），与反事实（预期）值相比，绝对值降低了 10.2%，相对率降低了 31.8%（34.7% → 21.9% [实际] vs 32.1%） [预期的]）。首先，2018 年前后 CN 和 LN 率的相对差异可能归因于除 CARMENA 出版物之外的其他因素，未在此准实验模型中进行测试。 2018 年 CARMENA 试验发表后，CN 率显着下降，差异极小区域或人口实践模式。总体而言，CARMENA 试验结果的发布似乎与美国临床实践的重大改变相关，在各个机构、地区和人口统计中得到相对广泛和非特异性的采用。几十年来，立即手术切除肾肿瘤（细胞减灭性肾切除术） ）是转移性肾癌治疗的支柱。 2018年，CARMENA研究表明，单独接受全身治疗的患者与首先接受肿瘤细胞减灭术的患者具有相似的结果。在这项研究中，我们表明，CARMENA 试验结果发布后，进行的细胞减灭术肾切除术有所减少。版权所有 © 2024 欧洲泌尿外科协会。版权所有。

It is unclear whether cytoreductive nephrectomy (CN) practices have changed in the USA after the publication of the Cancer du Rein Métastatique Nephrectomie et Antiangiogéniques (CARMENA) trial in 2018. Our primary objective is to determine the effect of the CARMENA trial on CN rates in the USA.Patients were identified in the National Cancer Database from 2004 to 2020. A quasiexperimental difference-in-differences analysis was used to test the primary outcome, as follows: the change in CN rate was assessed among metastatic clear cell renal cell carcinoma (ccRCC) patients diagnosed before versus after 2018, while using the localized nephrectomy (LN) rate performed in the setting of nonmetastatic ccRCC as a control group.The difference-in-differences analysis identified a statistically significant decrease in CN rate after CARMENA (β-coefficient [standard error]: -0.06 [0.025], p = 0.028), with a 10.2% absolute and a 31.8% relative rate reduction when compared with the counterfactual (expected) value (34.7% → 21.9% [actual] vs 32.1% [expected]). Primarily, relative differences in CN and LN rates before and after 2018 may be attributable to additional factors, aside from CARMENA publication, not tested in this quasiexperimental model.CN rates decreased significantly after the publication of the CARMENA trial in 2018, with a minimal difference in regional or demographic practice patterns. Overall, the publication of the CARMENA trial results is seemingly associated with substantial alteration of clinical practice in the USA, with relatively broad and nonspecific adoption across facilities, regions, and demographics.For decades, the immediate surgical removal of the kidney tumor (cytoreductive nephrectomy) was a mainstay of metastatic kidney cancer treatment. In 2018, the CARMENA study showed that patients treated with systemic therapy alone had similar outcomes to patients who underwent cytoreductive nephrectomy first. In this study, we show that fewer cytoreductive nephrectomies were performed after the CARMENA trial results were published.Copyright © 2024 European Association of Urology. All rights reserved.