Cui Kongkong,Yang Shuhan,Tian Xiaomao,et al.Treatments and prognoses of recurrent Wilms’ tumor in children: a retrospective study at a single center[J].Journal of Clinical Pediatric Surgery,2025,(10):934-939.[doi:10.3760/cma.j.cn101785-202507009-006]
儿童肾母细胞瘤复发风险因素及预后:单中心回顾性分析
- Title:
- Treatments and prognoses of recurrent Wilms’ tumor in children: a retrospective study at a single center
- Keywords:
- Wilms Tumor; Recurrence; Risk Factors; Prognosis; China
- 摘要:
- 目的 探讨肾母细胞瘤(Wilms tumor,WT)复发风险因素及临床预后。方法 回顾性分析重庆医科大学附属儿童医院泌尿外科2004年1月至2023年12月收治的250例WT患儿临床资料,按照是否复发分为复发组和未复发组,收集两组患儿性别、就诊年龄、肿瘤分期、分型、术前化疗史和诊断时转移状态等信息。采用多因素Logistic回归分析WT复发的相关因素,采用Kaplan-Meier法计算WT患儿生存率。结果 250例中,32例(12.8%)复发,218例(87.2%)未复发。复发组从术后到复发经历时间平均为9.3(5.3,17.6)个月;其中原位复发16例、转移性复发8例、多部位复发(原位+转移)8例。单因素及多因素分析结果显示,就诊时年龄>4岁是WT术后复发的独立危险因素(P＜0.05)。32例复发患儿中,22例予手术及化疗,其中13例存活,9例死亡;9例仅行化疗,其中5例存活,4例死亡;1例手术后放弃治疗。14例死亡患儿死亡原因依次为:治疗相关并发症(5/14,35.7%)、肿瘤进展(4/14,28.6%)、严重感染(3/14,21.4%)、电解质紊乱(1/14,7.1%)及肿瘤破裂出血(1/14,7.1%)。结论 年龄4岁以上的WT患儿治疗后更容易复发。复发WT患儿死亡风险高。充分评估复发危险因素,尽早识别并积极干预,对于改善预后、提高生存质量极为重要。
- Abstract:
- Objective To explore the risk factors associated with recurrence and prognoses of Wilms tumor (WT). Methods A retrospective analysis was conducted for the relevant clinical data of 250 WT children admitted from January 2004 to December 2023.They were assigned into two groups of recurrence (n=32,12.8%) and non-recurrence (n=218,87.2%).Gender,age at presentation,tumor stage,subtype,history of preoperative chemotherapy and metastatic status at diagnosis was recorded.Multivariate Logistic regression analysis was performed to examine the influencing factors of WT recurrence and Kaplan-Meier method to calculate the survival rate. Results Time from surgery to recurrence in recurrence group was 9.3 (5.3,17.6) month.Recurrence was local (n=16),metastatic (n=8) and multiple site (n=8) (local+metastatic).Univariate and multivariate analyses revealed that age >4 year at presentation was an independent risk factor for recurrence after WT surgery.And 22/32 recurrent cases underwent surgery and chemotherapy.Outcome was survival (n=13) and death (n=9).Among 9 cases on chemotherapy,5 survived and 4 died; 1 refused treatment.The causes of death in 14 deceased cases included treatment-related complications (5/14,35.7%),tumor progression (4/14,28.6%),severe infection (3/14,21.4%),electrolyte imbalance (1/14,7.1%) and tumor rupture & hemorrhage (1/14,7.1%). Conclusions WT children aged 4 year or above are more prone to experience recurrence after treatment.There is a high mortality risk among children with recurrent wilms tumor.Thoroughly assessing risk factors for recurrence,early identification and proactive intervention are crucial for improving prognoses and enhancing quality-of-life.
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备注/Memo
收稿日期:2025-7-4。
基金项目:国家科学自然基金(82302948)
通讯作者:石秦林,Email:485141@hospital.cqmu.edu.cn