术前化疗对肾母细胞瘤瘤体的影响

The effect of preoperative chemotherapy on nephroblastomas

目的 探讨术前化疗对肾母细胞瘤瘤体大小及瘤体耐药的影响。方法 本组 37例 ,术前影像学分期 ,Ⅰ～Ⅱ期 ,手术切除 ;Ⅲ～Ⅴ期 ,术前化疗 2～ 6周。免疫组化检测术后瘤体组织P 糖蛋白 (P glycoprotein ,P gp)、谷胱甘肽 硫转移酶 (glutathione s transferase π ,GST π)、拓扑异构酶Ⅱ(topoisomeraseⅡα ,TOPOⅡ )表达状况。结果 影像学分期 ,Ⅰ～Ⅱ期 2 0例 ,Ⅲ～Ⅴ期 17例。术前化疗组 ,瘤体缩减率 :1～ 2周为 (18.84± 3.5 4 ) %、3～ 4周为 (10 .78± 4 .2 6 ) %、5～ 6周为 (3.18±1.0 8) % ;瘤体GST π、TOPOⅡ表达阴性。瘤体在术前化疗 2周以内无P gp表达 ,4周以内有或弱阳性表达 ,4周以后P gp表达阳性。 结论 术前化疗应针对Ⅲ～Ⅴ期患儿 ,瘤体缩小主要集中于化疗 4周以内 ,超过 4周瘤体缩小不明显 。

Objective To assess the relationship between tumor size and drug resistance of nephroblastomas after preoperative chemotherapy.Methods Of the 37 cases,20 patients (between stage I II) underwent operation,another 17 (stage III IV) received pre operative chemotherapy.The expressions of P glycoprotein(P gp),glutathione s transferase and topoisomerase II α (TOPOII) in nephroblastoma tissues were examined using immunohistochemical techniques.Results (18.84 ± 3.54%) of tumors decreased in size between 0～2 weeks, (10.78 ± 4.26%) between 3～4 weeks?and (3.18±1.08%) between 5～6 weeks. The expression of P gp was positive whereas the expression of GST π and TOPOII were negative in tumor tissues from patients who underwent more than 4 weeks of chemotherapy.Conclusions Preoperative chemotherapy should aim at cases with nephroblastomas in stage III IV.Tumor size decreases mainly within 4 weeks of chemotherapy pre operatively.The drug resistance may develop if preoperative chemotherapy lasts more than 4 weeks.