Tan Vivian S, Correa Rohann J M, Warner Andrew, Ali Muhammad, Muacevic Alexander, Ponsky Lee, Ellis Rodney J, Lo Simon S, Onishi Hiroshi, Swaminath Anand, Suk Kwon Young, Morgan Scott C, Cury Fabio L, Teh Bin S, Mahadevan Anand, Kaplan Irving D, Chu William, Hannan Raquibul, Staehler Michael, Zaorsky Nicholas G, Louie Alexander V, Siva Shankar
London Health Sciences Centre, London, ON, Canada.
Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
Eur Urol Oncol. 2024 Dec;7(6):1527-1534. doi: 10.1016/j.euo.2024.06.012. Epub 2024 Jul 9.
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.
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).
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.
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.
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.
对于局限性肾细胞癌（RCC）患者，非手术治疗后保留肾功能尤为重要，因为这些患者往往年龄较大且伴有内科合并症。我们的目的是报告立体定向消融放疗（SABR）后的长期肾功能结果，包括单肾患者。
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≥2年的原发性RCC患者。通过估算肾小球滤过率（eGFR）来测量肾功能。
共有190例患者（56例为单肾）接受了SABR治疗，中位随访时间为5.0年（四分位间距[IQR]：3.4 - 6.8年）。单肾患者与双侧肾患者相比，SABR前的eGFR（均值[标准差]）分别为61.1（23.2）和58.0（22.3）ml/min（p = 0.32），中位肿瘤大小分别为3.65 cm（IQR：2.59 - 4.50 cm）和4.00 cm（IQR：3.00 - 5.00 cm；p = 0.026）。SABR后5年，eGFR分别下降了-14.5（7.6）和-13.3（15.9）ml/min（p = 0.67），SABR后透析率相似（3.6%[n = 2/56]对3.7%[n = 5/134]）。多变量分析表明，肿瘤大小增加（每增加1 cm的比值比[OR]：1.57；95%置信区间[CI]：1.14 - 2.16，p = 0.0055）和基线eGFR（每增加10 ml/min的OR：1.30；95% CI：1.02 - 1.66，p = 0.034）与1年后eGFR下降≥15 ml/min相关。
经过SABR后的长期随访，肾功能下降仍为中度，单肾患者与双侧肾患者之间未观察到差异。肿瘤大小和基线eGFR是预测长期肾功能下降的主要因素。
经过长期随访，立体定向消融放疗（SABR）即使在单肾患者中也会导致中度的长期肾功能下降和较低的透析率。因此，SABR对于局限性肾细胞癌患者而言是一种有前景的非侵入性、保留肾单位的选择。
