Fan Xu,Yin Xiaoming,Liu Xin,et al.Study on the prognostic impact of preoperative glomerular filtration rate assessment in children with Wilms tumor[J].Journal of Clinical Pediatric Surgery,2025,(10):923-928.[doi:10.3760/cma.j.cn101785-202507028-004]
肾母细胞瘤患儿手术前肾小球滤过率精准检测对于预后的影响研究
- Title:
- Study on the prognostic impact of preoperative glomerular filtration rate assessment in children with Wilms tumor
- Keywords:
- Wilms Tumor; Surgical Procedures; Operative; Preoperative Period; Glomerular Filtration Rate; Prognosis; Correlation of Data
- 摘要:
- 目的 探讨术前肾小球滤过率(glomerular filtration rate,GFR)精准检测对于单侧肾母细胞瘤患儿预后的影响。方法 本研究为回顾性队列研究。收集2017年1月至2023年12月中国医科大学附属盛京医院收治的54例经病理检查确诊的单侧肾母细胞瘤患儿临床资料。观察指标包括初诊年龄、性别、国家Wilms瘤研究组-5(National Wilms Tumor Study-5,NWTS-5)分期、肿瘤大小、治疗方案[依据国际儿科肿瘤学会肾肿瘤研究组/北美儿童肿瘤学组肾肿瘤委员会(Children’s Oncology Group/International Society of Pediatric Oncology,COG/SIOP)]、病理类型、术前基于肾动态显像的患侧肾脏和健侧肾脏分肾功能(differential renal function,DRF)及肾小球滤过率(glomerular filtration rate,GFR-ECT),以及基于Schwartz公式计算的GFR(GFR-SCH)。采取单因素分析影响患儿存活的危险因素,并比较GFR-ECT与GFR-SCH的差异。本研究根据末次随访时患儿术后是否存活分为存活组和死亡组。进一步分析COG/SIOP标准下不同分期、不同风险分层以及不同病理类型肾母细胞瘤患儿GFR和DFR的特点。结果 54例患儿中,男30例,女24例;中位年龄26个月(范围:3个月至9岁);49例存活,5例死亡。单因素分析显示,术前总肾小球滤过率升高是死亡的危险因素(OR=1.047,P=0.018)。GFR-SCH(126.03±31.18 mL/min)显著高于GFR-ECT(88.78±35.22 mL/min),差异有统计学意义(t=-7.23,P<0.05)。COG/SIOP标准下不同分期患儿的DRF及GFR-ECT比较,差异无统计学意义(P>0.05),不同风险分层患儿的DRF及GFR-ECT比较,差异无统计学意义(P>0.05),不同病理类型患儿DRF及GFR-ECT比较,差异也无统计学意义(P>0.05)。结论 术前总肾小球滤过率升高是单侧肾母细胞瘤患儿预后不良的危险因素。基于肾动态显像精准检测的GFR对于预后评估具有重要价值。临床常用的Schwartz 公式估算 GFR显著高估肾母细胞瘤患儿实际肾功能,不建议其替代肾动态显像用于单侧肾母细胞瘤患儿术前肾功能评估。
- Abstract:
- Objective To investigate the impact of accurate preoperative glomerular filtration rate (GFR) measurement on the prognosis of children with unilateral Wilms tumor. Methods This retrospective cohort study included 54 children with pathologically confirmed unilateral Wilms tumor treated at Shengjing Hospital of China Medical University from January 2017 to December 2023.Clinical data were collected,including age at diagnosis,gender,National Wilms Tumor Study-5 (NWTS-5) staging,tumor size,treatment protocol [based on guidelines from the Children’s Oncology Group/International Society of Pediatric Oncology (COG/SIOP)],pathological type,and preoperative renal function (DRF) and GFR measured by dynamic imaging (GFR-ECT),as well as estimated GFR using the Schwartz formula (GFR-SCH).Univariate analysis was conducted to identify risk factors affecting survival.Differences between GFR-ECT and GFR-SCH were compared.All patients were divided into survival and non-survival groups based on postoperative outcomes.GFR and DFR values were further analyzed across different COG/SIOP stages,risk stratifications,and pathological subtypes. Results Among the 54 children,30 were male and 24 female,with a median age of 26 months (range:3 months to 9 years).A total of 49 children survived and 5 died.Univariate analysis showed that a higher total preoperative GFR was a significant risk factor for mortality (OR=1.047,P=0.018).The mean GFR-SCH was 126.03±31.18 mL/min,significantly higher than GFR-ECT (88.78±35.22 mL/min),with a statistically significant difference (t=-7.23,P<0.05).There were no statistically significant differences in DRF or GFR-ECT among different stages.Likewise,there were no significant differences in DRF or GFR-ECT across different risk stratifications.The differences in DRF and GFR between different pathological types were not statistically significant(P＞0.05). Conclusions Elevated total preoperative GFR is an independent risk factor for poor prognosis in children with unilateral Wilms tumor.GFR-ECT provides valuable prognostic information and demonstrates greater accuracy compared to the Schwartz formula (GFR-SCH).Therefore,GFR-SCH should not be used as a substitute for dynamic imaging-based GFR assessment in these patients.
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备注/Memo
收稿日期:2025-7-13。
基金项目:国家自然科学基金(82371722)
通讯作者:杨屹,Email:18940251106@163.com