Liu Pei,Yang Yang,Zhang Weiping,et al.Prognostic factors of stage Ⅲ favorable-histology Wilms tumor[J].Journal of Clinical Pediatric Surgery,,():929-933.[doi:10.3760/cma.j.cn101785-202306011-005]
Prognostic factors of stage Ⅲ favorable-histology Wilms tumor
- Keywords:
- Wilms Tumor; Neoplasm Staging; Neoplasms by Histologic Type; Prognosis; Root Cause Analysis
- Abstract:
- Objective To explore the prognostic differences of children with stage Ⅲ favorable-histology Wilms tumor (FHWT) of different staging factors and histological subtypes. Methods From March 2008 to June 2020,the clinicopathological data were retrospectively reviewed for 45 children of stage Ⅲ FHWT.Event-free survival rate (EFS) and overall survival rate (OS) of children with different stage Ⅲ factors and histological subtypes were compared. Results There were 29 boys and 16 girls with an average age of 35(28-57) month.The involved side was left (n=21) and right (n=24).All of them were staged and treated according to the protocol of COG (Children’s Oncology Group).There were lymph node metastasis (n=18,40.0%),preoperative tumor rupture plus intraoperative spillage (n=15,33.3%),tumor rupture plus lymph node metastasis (n=4,8.9%),tumor rupture plus peritoneal implantation (n=3,6.7%),intraoperative residual and peritoneal implantation (n=2,4.4%) and tumor rupture plus lymph node metastasis and peritoneal implantation (n=1,2.2%).The pathological types were mixed (n=21,46.67%),blastema (n=19,42.22%),epithelial (n=1,2.22%) and mesenchymal (n=4,8.89%).Ten cases had recurrence or metastasis during an average follow-up period of 43(19-67) month.Four-year EFS was 78% and four-year OS 93%.Univariate and multivariate analyses of impact of different staging factors on survival events (recurrence or metastasis) revealed that children with lymph node metastasis had the worst prognosis and the difference was statistically significant (P<0.05).The impact of different histological subtypes on the prognosis of stage Ⅲ FHWT was statistically insignificant (P>0.05).The recurrent probability of blastema and mixed types was relatively low (recurrent rate:blastema type 10.53%,mixed type 23.81%,mesenchymal type 50%,epithelial type 100%).The recurrent probability of blastema type was lower than that of mixed type. Conclusions Lymph node metastasis is an independent influencing factor for poor prognosis in children with stage Ⅲ FHWT.Individualized treatments are preferred for FHWT children with different stage Ⅲ factors.
References:
[1] Theilen TM,Braun Y,Bochennek K,et al.Multidisciplinary trea-tment strategies for Wilms tumor:recent advances,technical innovations and future directions[J].Front Pediatr,2022,10:852185.DOI:10.3389/fped.2022.852185.
[2] 刘沛,杨洋,黄蕾,等.肾母细胞瘤常规行淋巴结清扫术对预后的影响研究[J].临床小儿外科杂志,2022,21(12):1111-1115.DOI:10.3760/cma.j.cn101785-202205079-003. Liu P,Yang Y,Huang L,et al.Outcomes of event-free survival in children with Wilms tumor undergoing routine lymph node dissection[J].J Clin Ped Sur,2022,21(12):1111-1115.DOI:10.3760/cma.j.cn101785-202205079-003.
[3] Zhang Y,Song HC,Yang YF,et al.Preoperative Wilms tumor rupture in children[J].Int Urol Nephrol,2021,53(4):619-625.DOI:10.1007/s11255-020-02706-5.
[4] Brisse HJ,Schleiermacher G,Sarnacki S,et al.Preoperative Wilms tumor rupture:a retrospective study of 57 patients[J].Cancer,2008,113(1):202-213.DOI:10.1002/cncr.23535.
[5] Flores P,Cadario M,Strambach J,et al.Outcomes of event-free survival in patients with Wilms tumor undergoing preoperative chemotherapy.Analysis of lymph-node yield in a single-center cohort[J].J Pediatr Urol,2021,17(2):227.e1-227.e5.DOI:10.1016/j.jpurol.2020.11.027.
[6] Huang YY,Zhang WP,Song HC,et al.A nomogram for prediction of distant metastasis in children with Wilms tumor:a study based on SEER database[J].J Pediatr Urol,2020,16(4):473.e1-473.e9.DOI:10.1016/j.jpurol.2020.05.158.
[7] Aoba T,Urushihara N,Fukumoto K,et al.Relapse of unilateral favorable histology Wilms’ tumor:significant clinicopathological factors[J].J Pediatr Surg,2012,47(12):2210-2215.DOI:10.1016/j.jpedsurg.2012.09.010.
[8] Alburquerque-González B,López-Calderón FF,López-Abellán MD,et al.Biology and therapeutic targets of colorectal serrated adenocarcinoma; clues for a histologically based treatment against an aggressive tumor[J].Int J Mol Sci,2020,21(6):1991.DOI:10.3390/ijms21061991.
[9] Fernandez CV,Mullen EA,Chi YY,et al.Outcome and prognostic factors in stage Ⅲ Favorable-Histology Wilms tumor:a report from the Children’s Oncology Group study AREN0532[J].J Clin Oncol,2018,36(3):254-261.DOI:10.1200/JCO.2017.73.7999.
[10] Dix DB,Fernandez CV,Chi YY,et al.Augmentation of therapy for combined loss of heterozygosity 1p and 16q in favorable histology Wilms tumor:a Children’s Oncology Group AREN0532 and AREN0533 study report[J].J Clin Oncol,2019,37(30):2769-2777.DOI:10.1200/JCO.18.01972.
[11] Vokuhl C,Vogelgesang W,Leuschner I,et al.1q gain is a frequent finding in preoperatively treated Wilms tumors,but of limited prognostic value for risk stratification in the SIOP2001/GPOH trial[J].Genes Chromosomes Cancer,2014,53(11):960-962.DOI:10.1002/gcc.22203.
[12] Hu X,Wu CH,Cowan JM,et al.Outcomes of patients with multiple myeloma harboring chromosome 1q gain/amplification in the era of modern therapy[J].Ann Hematol,2022,101(2):369-378.DOI:10.1007/s00277-021-04704-8.
[13] Pasqualini C,Furtw?ngler R,van Tinteren H,et al.Outcome of patients with stage IV high-risk Wilms tumour treated according to the SIOP2001 protocol:a report of the SIOP Renal Tumour Study Group[J].Eur J Cancer,2020,128:38-46.DOI:10.1016/j.ejca.2020.01.001.
Memo
收稿日期:2023-6-6。
基金项目:北京市科委、中关村管委会"医药创新品种及平台培育"专项资助(Z231100004823034)
通讯作者:张潍平,Email:zhangwpp@163.com