儿童复发性肾母细胞瘤临床特点和治疗经验

Clinical Characteristics and Experience of Treatment in Children with Relapsed Wilms′ Tumor

目的探讨儿童复发性肾母细胞瘤临床特点和治疗经验。方法回顾性研究2003年1月-2011年4月收治的17例儿童复发性肾母细胞瘤临床资料。其中9例采用手术联合术前术后化疗、放疗治疗方法。采用SPSS 17.0软件进行统计学处理,运用Kaplan-Meier曲线进行生存率分析。结果本组病例按美国肾母细胞瘤研究组织(NWTSG)临床分期分为Ⅰ期4例、Ⅱ期8例、Ⅲ期3例、Ⅳ期1例、Ⅴ期1例。原发瘤与复发瘤病理类型一致,其中预后良好型12例,预后不良型5例。全组有9例共接受12次再次手术,其中根治性切除1次,肿瘤单纯切除11次,术后化疗9例,放疗3例。再次手术组1 a累积生存率高于未再次手术组,差异有统计学意义(P<0.05)。结论尽管肾母细胞瘤可能反复复发,但病理类型仍然与原发瘤保持一致。治疗策略在于尽可能完整切除复发瘤和转移瘤,同时联合术前术后化疗、放疗可以提高患者生存率。

Objective To explore the experience of treatment in children with relapsed Wilms＇ tumor （WT）. Methods Retrospective study on 17 cases with relapsed WT from Jan. 2003 to Apr. 2011 was performed. The treatment of 9 cases among the total included tumorectomy ,chemotherapy and radiotherapy. Clinical data were analyzed by SPSS 17.0 statistics software and survival rate was analyzed by Kaplan - Meier curve. Results According to the National Wilms＇ Tumor Study Group（NWTSG） classification system. The postoperative staging were Ⅰ stage 4 cases, Ⅱ stage 8 cases, Ⅲ stage 3 cases, 1V stage 1 case, Vstage Ⅰ case. The pathological diagnosis of WT had not distinction in both primarily tumor and recurrence tumor. There were favourable histological type 12 cases and unfavourable histological type 5 cases. Nine cases accepted 12 vices salvage operations. There were radical excision 1 vice and tumorectomy 11 vices among the total. The postoperative chemotherapy were 9 cases. The postoperative radiotherapy were 3 cases. The survival rate of 1 year in those cases which accepted salvage operation was significantly higher than those which did not accepted operation （ P 〈 0.05 ）. Conclusions In spite of WT would be repeated relapse, but the tumor＇s pathology would not change. The recurrence and metastatic tumor shoud be resected as far as possible,combination chemotherapy and radiation could increase the relapsed WT＇s survival rate.