立体定向消融放疗（SABR）在原发性肾癌罕见亚型中的疗效：来自国际肾脏放射肿瘤学联盟的分析

Efficacy of Stereotactic Ablative Body Radiotherapy (SABR) in uncommon subtypes of primary kidney cancer: An analysis from the International Radiosurgery Oncology Consortium of the Kidney.

作者信息

Ali Muhammad, Correa Rohann J M, Pryor David, Higgs Braden, Sridharan Swetha, Sidhom Mark, Muacevic Alexander, Onishi Hiroshi, Swaminath Anand, Grubb William, Yang Daniel X, Grant Aurelie, Morgan Scott C, Ponsky Lee, Cury Fabio L, Teh Bin S, Lo Simon S, Mahadevan Anand, Kaplan Irving D, Chu William, Hannan Raquibul, Staehler Michael, Zaorsky Nicholas G, Warner Andrew, Louie Alexander V, Siva Shankar

机构信息

Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.

London Health Sciences Centre, London, ON, Canada.

出版信息

Int J Radiat Oncol Biol Phys. 2025 Sep 2. doi: 10.1016/j.ijrobp.2025.08.043.

DOI:10.1016/j.ijrobp.2025.08.043

PMID:40907772

Abstract

BACKGROUND

While stereotactic ablative body radiotherapy (SABR) is associated with excellent local control for primary renal cell carcinoma (RCC), outcomes based on clear-cell (ccRCC) and non-clear cell (nccRCC) histologies are not well defined.

METHODS AND MATERIALS

Individual data of adult patient with biopsy confirmed primary RCC receiving SABR between 2007 and 2021 from 16 institutions in Australia, Canda, Germany, Japan and USA pooled. Patients with metastatic disease or upper tract urothelial carcinoma were excluded. The primary outcome was local failure (LF), based on the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Distant failure (DF), cancer-specific survival (CSS), treatment related toxicity and renal function changes following SABR were defined as secondary outcomes. Kaplan-Meier estimates were generated for LF, DF and CSS stratified by clear cell vs. non-clear cell histology, compared using the log-rank test (CSS) or Gray's test (LF and DF).

RESULTS

Two hundred and eleven patients with a biopsy confirmed ccRCC (n=167) or nccRCC (n=44) were included. In the nccRCC group, 59% (n=26/44) and 11% (n=5/44) were papillary and chromophobe histologies, respectively. Patients with nccRCC were more likely to be older (median age at SABR 77.2 years vs. 71.5, p=0.009) and to be treated with multifraction SABR (82% [n=36/44] vs. 38% [n=63/167]; p < 0.001) than the ccRCC group. The median follow-up was 4.02 years (IQR: 3.43-4.94) and 4.25 years (IQR: 3.02-5.00) for ccRCC and nccRCC groups, respectively. The 5-year cumulative incidence of LF was 1.5% (95% confidence interval [CI]: 0.3-4.8%) in ccRCC group vs. 2.4% (95% CI: 0.2-11.0%) in nccRCC group (hazard ratio [HR]: 0.90, 95% CI: 0.10-8.31, p=0.922). The corresponding cumulative incidence of DF at 5-years was 6.0% in ccRCC group vs. 2.9% in nccRCC group (HR: 0.34, 95% CI: 0.04-2.68, p=0.304). The 5-year estimated CSS was 96.4% in ccRCC group vs. 96.4% in nccRCC group (HR: 2.04, p=0.561). From baseline, eGFR reduced by 11.4 ± 13.4 mL/min at 3 years and by 12.2 ± 14.0 mL/min at 5 years. Sixteen patients (7.6%) experienced grade-2 or higher toxicities, with grade-2 fatigue (5.7%) being the most common.

CONCLUSION

SABR provides excellent oncologic outcomes, irrespective of ccRCC or nccRCC histology.

摘要

背景

虽然立体定向消融体部放射治疗（SABR）对原发性肾细胞癌（RCC）具有出色的局部控制效果，但基于透明细胞（ccRCC）和非透明细胞（nccRCC）组织学的治疗结果尚不明确。

方法和材料

汇总了2007年至2021年间在澳大利亚、加拿大、德国、日本和美国的16家机构接受SABR治疗且活检确诊为原发性RCC的成年患者的个体数据。排除有转移性疾病或上尿路尿路上皮癌的患者。主要结局是基于实体瘤疗效评价标准（RECIST）1.1版的局部失败（LF）。远处失败（DF）、癌症特异性生存（CSS）、SABR后的治疗相关毒性和肾功能变化被定义为次要结局。通过透明细胞与非透明细胞组织学分层生成LF、DF和CSS的Kaplan-Meier估计值，使用对数秩检验（CSS）或Gray检验（LF和DF）进行比较。

结果

纳入了211例活检确诊为ccRCC（n = 167）或nccRCC（n = 44）的患者。在nccRCC组中，分别有59%（n = 26/44）和11%（n = 5/44）为乳头状和嫌色细胞组织学类型。与ccRCC组相比，nccRCC患者年龄更大（SABR时的中位年龄为77.2岁对71.5岁，p = 0.009），且更可能接受多分次SABR治疗（82% [n = 36/44]对38% [n = 63/167]；p < 0.001）。ccRCC组和nccRCC组的中位随访时间分别为4.02年（IQR：3.43 - 4.94）和

4.25年（IQR：3.02 - 5.00）。ccRCC组5年LF累积发生率为1.5%（95%置信区间[CI]：0.3 - 4.8%），nccRCC组为2.4%（95% CI：0.2 - 11.0%）（风险比[HR]：0.90，95% CI：0.10 - 8.31，p = 0.922）。5年时ccRCC组DF的相应累积发生率为6.0%，nccRCC组为2.9%（HR：0.34，95% CI：0.04 - 2.68，p = 0.304）。ccRCC组5年估计CSS为96.4%，nccRCC组为96.4%（HR：2.04，p = 0.561）。从基线开始，3年时估算肾小球滤过率（eGFR）下降11.4 ± 13.4 mL/min，5年时下降12.2 ± 14.0 mL/min。16例患者（7.6%）经历了2级或更高等级的毒性反应，其中2级疲劳（5.7%）最为常见。