Yao Wei,Song Zhiyin,Yang Jiajian,et al.Preliminary analysis of nephron sparing surgery for unilateral Wilms tumor after neoadjuvant chemotherapy[J].Journal of Clinical Pediatric Surgery,2024,(04):372-376.[doi:10.3760/cma.j.cn101785-202403060-013]
单侧肾母细胞瘤新辅助化疗后保留肾单位手术的初步疗效分析
- Title:
- Preliminary analysis of nephron sparing surgery for unilateral Wilms tumor after neoadjuvant chemotherapy
- Keywords:
- Wilms Tumor; Surgical Procedures; Operative; Chemoradiotherapy; Adjuvant; Treatment Outcome
- 摘要:
- 目的 探讨新辅助化疗后保留肾单位手术(nephron sparing surgery,NSS)治疗单侧肾母细胞瘤的初步疗效。 方法 回顾性分析2014年1月至2020年12月复旦大学附属儿科医院收治的7例单侧肾母细胞瘤患儿临床资料,均行新辅助化疗及NSS。收集患儿生存率、肾功能以及肿瘤复发情况,并与同期行根治性肿瘤切除术(radical nephrectomy,RN)的患儿进行疗效比较。 结果 7例中,男4例、女3例,发病年龄(38.86±18.23)个月,无一例合并肿瘤相关综合征或半侧肢体肥大;肿瘤位于肾脏一极1例,肾脏中央6例。7例经新辅助化疗后,肿瘤体积缩小(66.4±18.6)%。1例肿瘤位于肾脏一极的患儿行部分肾切除术(partial nephrectomy,PN),6例肿瘤位于肾中央的患儿行肿瘤剜除术(tumor enucleation,TE),术后病理检查结果提示镜下肿瘤切缘阳性2例。儿童肿瘤国际协会(International Society for Pediatric Oncology,SIOP)分期:Ⅱ期4例、Ⅲ期3例。随访时间(38.42±10.17)个月,无一例失访或死亡。无瘤生存6例,带瘤生存1例。NSS后出现肿瘤复发2例。NSS后复发率(28.6%)及5年生存率(100%)与同期行RN的患儿复发率(13.3%)和5年生存率(86.9%)相比,差异均无统计学意义(P＞0.05)。 结论 单侧肾母细胞瘤通过合理的术前评估和新辅助化疗,可以增加NSS的机会,并取得与RN相似的治疗效果。
- Abstract:
- Objective To explore the preliminary therapeutic efficacy of nephron sparing surgery (NSS) for unilateral Wilms tumor after neoadjuvant chemotherapy. Methods From January 2014 to December 2020,retrospective analysis was conducted for the relevant clinical data of 7 children hospitalized with unilateral Wilms tumor (uWT) receiving neoadjuvant chemotherapy and undergoing NSS.Clinical parameters of tumor recurrence,renal function,and survival rate were recorded.And treatment outcomes were compared with matched cases of radical nephrectomy (RN) during the same period. Results There were 4 boys and 3 girls with an onset age of (38.86±18.23)(16-55) month.There was no tumor-related syndrome or hemihypertrophy.Renal tumor was located at pole (n=1) and center (n=6).After neoadjuvant chemotherapy,tumor shrank by (66.4%±18.6%)(53.3%-93.9%).One child with a pole renal tumor underwent partial nephrectomy (PN) while the remainders tumor enucleation (TE).Postoperative pathological examination indicated that microscopic tumor margins were positive (n=2).According to SIOP staging,the stages were Ⅱ(n=4) and Ⅲ(n=3).During a follow-up period of (38.42±10.17)(27-64) month,no case became lost or died.There were tumor-free survival (n=6) and 1 tumor-bearing survival (n=1).Two cases had tumor recurrence after NSS surgery.No statistically significant difference existed in recurrence rate (28.6%) and 5-year survival rate (100%) after NSS as compared with recurrence rate (13.3%) and 5-year survival rate (86.9%) of RN in the same period. Conclusions For uWT,proper preoperative evaluations and neoadjuvant chemotherapy may boost the proportion of NSS surgery and achieve similar therapeutic outcomes as RN.
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备注/Memo
收稿日期:2023-04-15。
基金项目:唐仲英基金会(ZSBK0070);厦门市小儿外科疾病重点实验室开放课题(CHP—2023—XKL—009)
通讯作者:董岿然,Email:kuirand@hotmail.com