肾母细胞瘤常规行淋巴结清扫术对预后的影响研究

Outcomes of event-free survival in children with Wilms tumor undergoing routine lymph node dissection

目的探讨常规行淋巴结清扫术对预后良好型肾母细胞瘤临床结局的影响。方法回顾性分析首都医科大学附属北京儿童医院自2008年3月至2020年5月收治的预后良好型肾母细胞瘤患儿的临床资料并进行随访,根据是否行淋巴结清扫术分为两组,即淋巴结采样组和淋巴结清扫组,比较两组淋巴结取样数量及阳性率,并进行生存分析,比较两组预后情况。结果共379例患儿纳入本研究,淋巴结采样组337例,中位淋巴结获取数量3枚[四分位数范围(interquartile range,IQR):1~4枚],阳性例数23例(23/337,6.8%);淋巴结清扫组42例,中位淋巴结获取数量12枚(IQR:8~15枚),阳性例数4例(4/42,9.5%)。淋巴结清扫组淋巴结获取数量明显多于淋巴结采样组(P<0.05),淋巴结清扫组淋巴结病检阳性率高于淋巴结采样组,但差异无统计学意义(P=0.164)。379例中317例获得随访,中位随访时间43个月(IQR:19~67个月),其中22例发生复发或转移,包括腹膜后复发11例、盆腔复发3例、肝转移2例、肺转移5例、脑转移1例;死亡9例。两组在病理分期、病理类型及年龄上比较,差异均无统计学意义(P>0.05)。K-M分析结果显示,淋巴结采样组及淋巴结清扫组2年无事件生存率分别为92.7%及94.8%,差异无统计学意义(P=0.580)。COX多因素分析结果显示病理分期为影响患儿无事件生存率的独立危险因素(P<0.01)。结论肾母细胞瘤行常规淋巴结清扫术对预后无明显影响。

Objective To evaluate the prognosis of routine lymph node dissection in Wilms tumor.Methods Retrospective review was conducted for clinicopathologic parameters of 379 children with favorable-histology Wilms tumor.Based upon the approach of lymph node yield,lymph node sampling(LNS,n=337)and lymph node dissection(LND,n=42)were assigned.Results The median lymph node yield were 3(IQR:1-4)with 23 lymph node positive in LNS group and 12(IQR:8-15)with 4 lymph node positive.The number of lymph node yield was statistically greater in LND group(P<0.05).Among 317 patients with a median follow-up period of 43 months(IQR:19-67 months),22 developed local recurrence or metastasis,including retroperitoneal recurrence(n=11),pelvic recurrence(n=3),hepatic metastasis(n=2),lung metastasis(n=5)and brain metastasis(n=1).There were 9 deaths.No significant inter-group difference existed in event-free survival rate(P=0.580).Conclusion The prognosis of Wilms tumor is not affected obviously by routine lymph node dissection.