Ali Muhammad, Bressel Mathias, Chang David, Oon Sheng F, Ravi Rajeev, Moon Daniel, Murphy Declan G, Eapen Renu S, Perera Marlon, Lawrentschuk Nathan, Azad Arun A, Chander Sarat, Shaw Mark, Hardcastle Nicholas, Siva Shankar
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
BJU Int. 2025 Oct;136(4):719-727. doi: 10.1111/bju.16843. Epub 2025 Jun 28.
To evaluate the predictive value of the R.E.N.A.L. ([R]adius, [E]xophytic/endophytic properties, [N]earness of tumour to the collecting system or sinus, [A]nterior/posterior descriptor, and [L]ocation relative to polar lines) nephrometry score (RNS) for outcomes following stereotactic ablative body radiotherapy (SABR) for primary renal cell carcinoma (RCC), as the impact of tumour complexity on outcomes following nephron-sparing SABR treatment is unclear.
This was a single institutional retrospective analysis of patients with primary RCC receiving SABR between 2012 and 2020. The primary outcome was the change in renal function post-SABR, measured by estimated glomerular filtration rate (eGFR), and the effect of baseline RNS on it was assessed using linear mixed models (LMMs).
A total of 90 patients with a median (interquartile range [IQR]) age of 77 (71-82) years and a median (IQR) follow-up of 4.8 (2.8-7.8) years were included. In all, 52 patients (58%) had T1b disease, nine (10%) had T2 disease, and three (3%) had T3 disease. The median (IQR) maximum tumour size was 4.6 (2.1-8.4) cm. Most patients had moderate-complex renal tumours with a median (IQR) RNS of 9 (7-10). The baseline median eGFR was 53.6 mL/min/1.73 m (95% confidence interval [CI] 49.7-57.5 mL/min/1.73 m). The eGFR declined by -8.1 mL/min/1.73 m (95% CI -6.5 to -9.6 mL/min/1.73 m) at 1 year. The P value for the post-SABR eGFR trajectory according to baseline RNS was P = 0.06. Two patients (2.2%) underwent dialysis. Three patients (3.3%) experienced local progression. The 3- and 5-year estimates for freedom from local failure were 97% (95% CI 89-99%), and 91% (95% CI 68-98%), respectively. Four (4.4%) patients experienced Grade 3 toxicities.
Stereotactic ablative body radiotherapy is an effective treatment option, with acceptable decline in renal function and toxicity for medically inoperable patients with complex primary kidney tumours. The association between baseline RNS and renal function trajectories is worthy of further investigation.
评估R.E.N.A.L.（[R]半径、[E]外生性/内生性特征、[N]肿瘤与集合系统或肾窦的接近程度、[A]前后描述符以及[L]相对于极线的位置）肾计量评分（RNS）对原发性肾细胞癌（RCC）立体定向消融体部放疗（SABR）后结局的预测价值，因为肾单位保留性SABR治疗中肿瘤复杂性对结局的影响尚不清楚。
这是一项对2012年至2020年间接受SABR的原发性RCC患者进行的单机构回顾性分析。主要结局是SABR后肾功能的变化，通过估计肾小球滤过率（eGFR）测量，并使用线性混合模型（LMMs）评估基线RNS对其的影响。
共纳入90例患者，中位（四分位间距[IQR]）年龄为77（71 - 82）岁，中位（IQR）随访时间为4.8（2.8 - 7.8）年。其中，52例（58%）患者为T1b期疾病，9例（10%）为T2期疾病，3例（3%）为T3期疾病。中位（IQR）最大肿瘤大小为4.6（2.1 - 8.4）cm。大多数患者患有中度复杂肾肿瘤，中位（IQR）RNS为9（7 - 10）。基线中位eGFR为53.6 mL/min/1.73 m²（95%置信区间[CI] 49.7 - 57.5 mL/min/1.73 m²）。1年时eGFR下降了 - 8.1 mL/min/1.73 m²（95% CI - 6.5至 - 9.6 mL/min/1.73 m²）。根据基线RNS的SABR后eGFR轨迹的P值为P = 0.06。2例（2.2%）患者接受了透析。3例（3.3%）患者出现局部进展。3年和5年局部无失败生存率估计分别为97%（95% CI 89 - 99%）和91%（95% CI 68 - 98%）。4例（4.4%）患者出现3级毒性反应。
立体定向消融体部放疗是一种有效的治疗选择，对于患有复杂原发性肾肿瘤且医学上无法手术的患者，其肾功能下降和毒性反应可接受。基线RNS与肾功能轨迹之间的关联值得进一步研究。
