Liu Pei,Yang Yang,Zhang Weiping,et al.Prognostic factors of stage Ⅲ favorable-histology Wilms tumor[J].Journal of Clinical Pediatric Surgery,2025,(10):929-933.[doi:10.3760/cma.j.cn101785-202306011-005]
Ⅲ期良好组织学肾母细胞瘤预后影响因素分析
- Title:
- Prognostic factors of stage Ⅲ favorable-histology Wilms tumor
- Keywords:
- Wilms Tumor; Neoplasm Staging; Neoplasms by Histologic Type; Prognosis; Root Cause Analysis
- 摘要:
- 目的 探讨不同分期因素与组织学亚型的Ⅲ期良好组织学肾母细胞瘤(favorable-histology Wilms tumor,FHWT)患儿预后差异及影响因素。方法 回顾性分析首都医科大学附属北京儿童医院2008年3月至2020年6月收治的Ⅲ期FHWT患儿临床与病理检查资料,并随访治疗效果。比较不同分期因素及组织学亚型患儿的无事件生存率(event-free survival,EFS)及总体生存率(overall survival,OS)。结果 本研究共纳入45例Ⅲ期FHWT患儿,男29例、女16例;平均年龄35个月(28~57个月);左侧21例,右侧24例。均按照儿童肿瘤协作组(Children’s Oncology Group,COG)制定的方案进行分期和治疗。45例中,淋巴结转移18例(40.0%),术前肿瘤破裂及术中肿瘤溢出15例(33.3%),肿瘤破裂合并淋巴结转移4例(8.9%),肿瘤破裂合并腹膜种植3例(6.7%),术中肿瘤残留及腹膜种植各2例(均为4.4%),肿瘤破裂合并淋巴结转移及腹膜种植1例(2.2%)。病理分型为混合型21例(46.67%),胚芽型19例(42.22%),上皮型1例(2.22%),间叶型4例(8.89%)。45例均获随访,平均随访43个月(19~67个月),其中10例发生复发或转移,4年EFS为78%,4年OS为93%。将不同分期因素对生存事件(复发或转移)的影响进行单因素及多因素分析发现,淋巴结转移患儿预后最差,与其他亚组相比差异有统计学意义(P<0.05)。不同组织学亚型对Ⅲ期FHWT患儿预后的影响差异无统计学意义(P>0.05),胚芽型及混合型复发率较低,胚芽型较混合型复发率更低(胚芽型10.53%,混合型23.81%,间叶型50%,上皮型100%)。结论 淋巴结转移是Ⅲ期FHWT患儿预后不良的独立影响因素。建议对于具有不同Ⅲ期分期因素的FHWT患儿采取不同的治疗方式。
- 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.
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备注/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