目的 探讨肾母细胞瘤 (Wilms tumor,WT)患者发生肺转移(pulmonary metastases,PM)的高危因素,为评估预后提供依据;总结WT患者发生肺转移的生存情况,指导临床治疗和用药。方法 选取自2006-01-01至2016-12-31武警总医院儿科经病理确诊的91例WT患儿的临床资料,按照是否发生肺转移,将91例分为肺转移组18例,无肺转移组73例。回顾性分析两组患儿详细临床资料,包括年龄、性别、发病部位、首发症状、初诊时肿瘤体积、组织学危险度分级、分期、Ki-67。结果 肺转移组>2岁占83.3%,无肺转移组>2岁占46.0%,差异有统计学意义(P=0.005);肺转移组患者初诊时腹部局部肿瘤体积大于无肺转移组,差异有统计学意义(P=0.017);肺转移组患者腹部分期多为Ⅱ、Ⅲ期,趋势卡方检验,差异有统计学意义(P=0.004)。在性别、肿瘤发生部位、危险度方面,P>0.05,与WT发生肺转移无关。肺转移组2年总存活率(overall survival,OS) 36.1%;无肺转移组2年OS是86.0%,差异具有统计学意义(P<0.01)。结论 WT IV期肺转移组患儿发病年龄大于无肺转移组患儿。肺转移组初诊时肿瘤体积大、腹部分期Ⅱ、Ⅲ期多见。肺转移组患儿较无肺转移组患儿总生存率低,预后差,复发及高危患儿通过个体化综合治疗仍能取得一定的缓解,但总生存率低,需要研究新的治疗方案,以提高疗效。
Abstract
Objective To investigate the risk factors of pulmonary metastases in children with stage Ⅳ Wilms tumor (WT) in order to provide data for the assessment of prognosis and guide clinical treatment and medication. Methods Ninety-one cases of WT confirmed pathologically in the General Hospital of Armed Police Force from January 1 2006 to December 31 2016 were selected as subjects. They were divided into the localized non-metastatic group (73 cases) and pulmonary metastases alone group (18 cases) according to chest CT. The clinical data of patients in the two groups was reviewed while age, sex, primary tumor localization, initial symptoms, tumor volume, risk stratification, tumor stage and Ki-67 of these patients were analyzed. Results The percentage of children above 2 years old was 83.3% and 46.0%, respectively, in patients with PM and localized disease.The difference was statistically significant(P=0.005). During the first visit, the tumor volume of the patients in the lung metastatic group was larger than that of the non-pulmonary metastasis group, and the difference was statistically significant(P=0.017). There were significantly more cases of stage Ⅱ and stage Ⅲ (abdominal stage) disease among patients with PM than among patients without metastases (P=0.004). The occurrence of PM of nephroblastoma was not related to sex or the location of the tumor. The percentage of 2-year 0S was 36.1% among patients with PM alone compared with 86.0% among patients in the local stage. The difference was statistically significant (P=0.000 <0.01). Conclusions Patients with PM are generally significantly older and have larger tumor volumes upon diagnosis than those with localized diseases. There are far more stage Ⅱ and stage Ⅲ (abdominal stage)cases of disease among patients with PM than among patients without metastases. The total survival rate of patients with lung metastasis is lower than that of the non-lung metastasis group. Through the individualized comprehensive treatment, the chance and risks of WT can still be reduced to some extent, but OS is low. New treatment programs need to be studied to improve efficacy.
关键词
肾母细胞瘤 /
肺转移 /
临床特点 /
相关因素 /
预后 /
儿童
Key words
nephroblastoma /
pulmonary metastases /
clinical features /
relevant factor /
prognosis /
children
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