放疗与部分肾切除术治疗非转移性 T1a 肾细胞癌的肿瘤特异性死亡率。
Cancer-specific mortality in non-metastatic T1a renal cell carcinoma treated with radiotherapy versus partial nephrectomy.
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.
Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.
出版信息
World J Urol. 2024 Mar 26;42(1):193. doi: 10.1007/s00345-024-04856-y.
PURPOSE
Radiotherapy (RT) represents a treatment option for small renal masses with proven feasibility and tolerability. However, it has never been directly compared to partial nephrectomy (PN) with cancer-specific mortality (CSM) as an endpoint.
METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified T1aN0M0 renal cell carcinoma (RCC) patients treated with RT or PN. We relied on 1:1 propensity score matching (PSM) for age, tumor size and histology. Subsequently, cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. The same methodology was then re-applied to a subset of patients with tumor size 21-40 mm.
RESULTS
Of 40,355 patients with T1aN0M0 RCC, 40,262 underwent PN (99.8%) vs 93 underwent RT (0.2%). RT patients were older (median age 72 vs 60 years, p < 0.001) and harbored larger tumor size (median size 28 vs 25 mm, p < 0.001) and a higher proportion of non-clear cell RCC (49% vs 22%, p < 0.001). After 1:1 PSM (92 RT versus 92 PN patients), cumulative incidence plots' derived CSM was 21.3 vs 4%, respectively. In multivariable CRR models, RT independently predicted higher CSM (hazard ratio (HR) 4.3, p < 0.001). In the subgroup with tumor size 21-40 mm, after 1:1 PSM (72 RT versus 72 PN patients), cumulative incidence plots derived CSM was 21.3% vs 4%, respectively. In multivariable CRR models, RT also independently predicted higher CSM (HR 4.7, p = 0.001).
CONCLUSIONS
In T1aN0M0 RCC patients, relative to PN, RT is associated with significantly higher absolute and relative CSM, even in patients with tumor size 21-40 mm.
目的
放射治疗（RT）是一种治疗小肾肿瘤的方法，具有良好的可行性和耐受性。然而，它从未被直接与作为终点的部分肾切除术（PN）进行过比较，以评估癌症特异性死亡率（CSM）。
方法
我们在监测、流行病学和最终结果数据库（2004-2020 年）中，确定了接受 RT 或 PN 治疗的 T1aN0M0 肾细胞癌（RCC）患者。我们依靠年龄、肿瘤大小和组织学的 1:1 倾向评分匹配（PSM）。随后，拟合累积发生率图和多变量竞争风险回归（CRR）模型。然后，我们将相同的方法应用于肿瘤大小为 21-40mm 的患者亚组。
结果
在 40355 名 T1aN0M0 RCC 患者中，40262 名接受了 PN（99.8%），93 名接受了 RT（0.2%）。RT 患者年龄更大（中位年龄 72 岁 vs 60 岁，p<0.001），肿瘤更大（中位大小 28 毫米 vs 25 毫米，p<0.001），非透明细胞 RCC 的比例更高（49% vs 22%，p<0.001）。经过 1:1 PSM（92 例 RT 与 92 例 PN 患者）后，累积发生率图得出的 CSM 分别为 21.3%和 4%。在多变量 CRR 模型中，RT 独立预测更高的 CSM（风险比（HR）4.3，p<0.001）。在肿瘤大小为 21-40mm 的亚组中，经过 1:1 PSM（72 例 RT 与 72 例 PN 患者）后，累积发生率图得出的 CSM 分别为 21.3%和 4%。在多变量 CRR 模型中，RT 也独立预测更高的 CSM（HR 4.7，p=0.001）。
结论
在 T1aN0M0 RCC 患者中，与 PN 相比，RT 与更高的绝对和相对 CSM 显著相关，即使在肿瘤大小为 21-40mm 的患者中也是如此。
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