包括单肾患者在内的原发性肾细胞癌立体定向消融体放射治疗后的长期肾功能预后:国际肾脏放射外科肿瘤联盟的报告。

IF 8.3 1区 医学 Q1 ONCOLOGY
European urology oncology Pub Date : 2024-12-01 Epub Date: 2024-07-09 DOI:10.1016/j.euo.2024.06.012
Vivian S Tan, Rohann J M Correa, Andrew Warner, Muhammad Ali, Alexander Muacevic, Lee Ponsky, Rodney J Ellis, Simon S Lo, Hiroshi Onishi, Anand Swaminath, Young Suk Kwon, Scott C Morgan, Fabio L Cury, Bin S Teh, Anand Mahadevan, Irving D Kaplan, William Chu, Raquibul Hannan, Michael Staehler, Nicholas G Zaorsky, Alexander V Louie, Shankar Siva
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引用次数: 0

摘要

背景和目的:由于局部性肾细胞癌(RCC)患者通常年龄较大并伴有内科合并症,因此非手术治疗后的肾功能保护尤为重要。我们的目的是报告包括单肾患者在内的立体定向消融放射治疗(SABR)后的长期肾功能结果:方法:纳入在12家国际肾脏放射外科联盟机构接受SABR治疗且随访时间≥2年的原发性RCC患者。主要研究结果和局限性:共有 190 位患者(56 位为单肾患者)接受了 SABR,随访时间中位数为 5.0 年(四分位数间距 [IQR]:3.4-6.8)。单肾患者与双肾患者相比,SABR 前 eGFR(平均值 [标准差])为 61.1 (23.2) ml/min 对 58.0 (22.3) ml/min (p = 0.32),肿瘤大小中位数为 3.65 cm (IQR: 2.59-4.50 cm) 对 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026)。SABR 术后 5 年,eGFR 分别下降了 -14.5 (7.6) ml/min 和 -13.3 (15.9) ml/min (p = 0.67),SABR 术后透析率相似(3.6% [n = 2/56] vs 3.7% [n = 5/134])。多变量分析表明,肿瘤大小增加(每 1 厘米的几率比[OR]:1.57;95% 置信区间1.57; 95% 置信区间 [CI]:1.14-2.16, p = 0.0055)和基线 eGFR(每 10 毫升/分钟 OR:1.30;95% 置信区间 [CI]:1.02-1.66, p = 0.034)与 1 年后 eGFR 下降≥15 毫升/分钟有关:SABR术后的长期随访显示,肾功能仍有中度下降,在单肾和双肾患者之间未观察到差异。肿瘤大小和基线 eGFR 是预测长期肾功能衰退的主要因素。患者总结:经过长期随访,立体定向消融放射治疗(SABR)即使对单侧肾脏患者也能产生中度的长期肾功能衰退和较低的透析率。因此,对于局部肾细胞癌患者来说,立体定向消融放射治疗是一种很有前景的非侵入性、保留肾脏的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term Renal Function Outcomes After Stereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma Including Patients with a Solitary Kidney: A Report from the International Radiosurgery Oncology Consortium of the Kidney.

Background and objective: Renal function preservation is particularly important following nonoperative treatment of localized renal cell carcinoma (RCC) since patients are often older with medical comorbidities. Our objective was to report long-term renal function outcomes after stereotactic ablative radiotherapy (SABR) including patients with a solitary kidney.

Methods: Patients with primary RCC treated with SABR with ≥2 yr of follow-up at 12 International Radiosurgery Consortium for Kidney institutions were included. Renal function was measured by estimated glomerular filtration rate (eGFR).

Key findings and limitations: In total, 190 patients (56 with a solitary kidney) underwent SABR and were followed for a median of 5.0 yr (interquartile range [IQR]: 3.4-6.8). In patients with a solitary kidney versus bilateral kidneys, pre-SABR eGFR (mean [standard deviation]) was 61.1 (23.2) versus 58.0 (22.3) ml/min (p = 0.32) and the median tumor size was 3.65 cm (IQR: 2.59-4.50 cm) versus 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026). At 5 yr after SABR, eGFR decreased by -14.5 (7.6) and -13.3 (15.9) ml/min (p = 0.67), respectively, and there were similar rates of post-SABR dialysis (3.6% [n = 2/56] vs 3.7% [n = 5/134]). A multivariable analysis demonstrated that increasing tumor size (odds ratio [OR] per 1 cm: 1.57; 95% confidence interval [CI]: 1.14-2.16, p = 0.0055) and baseline eGFR (OR per 10 ml/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) were associated with an eGFR decline of ≥15 ml/min at 1 yr.

Conclusions and clinical implications: With long-term follow-up after SABR, kidney function decline remains moderate, with no observed difference between patients with a solitary kidney and bilateral kidneys. Tumor size and baseline eGFR are dominant factors predictive of long-term renal function decline.

Patient summary: With long-term follow-up, stereotactic ablative radiotherapy (SABR) yields moderate long-term renal function decline and low dialysis rates even in patients with a solitary kidney. SABR thus represents a promising noninvasive, nephron-sparing option for patients with localized renal cell carcinoma.

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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
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