立体定向体部放疗中生物学等效剂量对肾癌的预后影响
Prognostic impact of biologically equivalent dose in stereotactic body radiotherapy for renal cancer.
作者信息
Tran Kevin T, Chevli Neil C, Messer Jay A, Haque Waqar, Farach Andrew M, Satkunasivam Raj, Zhang Jun, Darcourt Jorge, Lo Simon S, Siva Shankar, Butler Edward B, Teh Bin S
机构信息
Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX, United States.
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States.
出版信息
Clin Transl Radiat Oncol. 2023 Feb 8;39:100592. doi: 10.1016/j.ctro.2023.100592. eCollection 2023 Mar.
PURPOSE /OBJECTIVES MATERIALS/METHODS: The National Cancer Database (NCDB) was queried (2004-2017) for patients with RCC who did not have surgical resection but received definitive SBRT. Kaplan-Meier analysis with log-rank test was used to evaluate overall survival (OS). Univariable (UVA) and multivariable (MVA) analysis were conducted using cox proportional hazard models to determine prognostic factors for OS.
RESULTS
A total of 344 patients with median age 77 (IQR 70-85) were included in this study. Median BED was 180 Gy (IQR 126.03-233.97). Median OS was 90 months in the highest quartile compared to 36-52 months in the lower three quartiles (p < 0.01). On UVA, the highest BED quartile was a positive prognostic factor (HR 0.67, p < 0.01 CI 0.51-0.91) while age, tumor size, -stage, metastasis, renal pelvis location, and transitional cell histology were negative factors. On MVA, the highest BED quartile was remained significant (HR 0.69, p = 0.02; CI 0.49-0.95) as a positive factor, while age, metastasis were negative factors.
CONCLUSION
Higher BED may be associated with improved OS. Prospective investigation is needed to clearly define optimal BED for SBRT used to treat RCC.
目的/目标 材料/方法：查询国家癌症数据库（NCDB，2004 - 2017年）中未接受手术切除但接受了根治性立体定向体部放疗（SBRT）的肾细胞癌（RCC）患者。采用Kaplan - Meier分析和对数秩检验评估总生存期（OS）。使用Cox比例风险模型进行单变量（UVA）和多变量（MVA）分析，以确定OS的预后因素。
结果
本研究共纳入344例患者，中位年龄77岁（四分位间距70 - 85岁）。中位生物等效剂量（BED）为180 Gy（四分位间距126.03 - 233.97）。最高四分位数组的中位OS为90个月，而较低的三个四分位数组为36 - 52个月（p < 0.01）。在单变量分析中，最高BED四分位数是一个阳性预后因素（风险比[HR] 0.67，p < 0.01，可信区间[CI] 0.51 - 0.91），而年龄、肿瘤大小、分期、转移、肾盂位置和移行细胞组织学是阴性因素。在多变量分析中，最高BED四分位数作为阳性因素仍然显著（HR 0.69，p = 0.02；CI 0.49 - 0.95），而年龄、转移是阴性因素。
结论
较高的BED可能与OS改善相关。需要进行前瞻性研究以明确用于治疗RCC的SBRT的最佳BED。
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