儿童中晚期肾母细胞瘤术前经肾动脉栓塞化疗的疗效对比评价

Comparative evaluation of preoperation transcatheter arterial chemoembolization in children with advanced wilms tumor

目的对比评价术前经肾动脉化疗栓塞(TACE)、经肾动脉灌注化疗(TAIC)和全身静脉化疗对儿童中晚期肾母细胞瘤的疗效及预后。方法回顾性分析浙江大学医学院附属儿童医院2007年1月至2018年12月经手术及病理证实的60例肾母细胞瘤。以肾母细胞瘤患儿术前44例TACE组为研究组,以术前7例TAIC组和9例静脉化疗组为对照组,对比分析三组患儿治疗前后影像学检查、治疗安全性和远期疗效的差异。观察指标有肿瘤减积率、包膜完整率、坏死率、术后不良反应及随访情况。结果TACE组、TAIC组、静脉化疗组比较,肿瘤减积率:TACE组肿瘤平均缩小46.5%,TAIC组肿瘤平均缩小28.3%,静脉化疗组肿瘤缩小23.3%,TACE组与静脉化疗组肿瘤减积率差异有统计学意义(P<0.05)。肿瘤坏死率:TACE组肿瘤均有不同程度坏死,坏死面积占46.0%~95.4%,平均75.1%±12.5%,高于静脉化疗组(65.8%±8.7%),差异有统计学意义(P<0.01)。三组患儿肿瘤包膜完整率分别为86.4%(38/44)、5/7和6/9,TACE组与静脉化疗组比较,差异有统计学意义(P<0.05)。三组患儿化疗后均行手术切除,无死亡病例。44例TACE组治疗后仅5例出现骨髓抑制,对比7例TAIC组治疗后出现4例骨髓抑制和9例静脉化疗组治疗后出现8例骨髓抑制,差异有统计学意义。TACE组随访时间20~92个月(中位时间64个月),无瘤生存率95.0%;TAIC组随访时间12~69个月(中位时间30个月),无瘤生存率43.0%;静脉化疗组随访时间16~72个月(中位时间28个月),无瘤生存率56.0%。结论术前TACE能使肿瘤缩小和坏死更明显,全身不良反应小,肿瘤完整切除率更高,手术也更安全,可有效提高生存率,更适用于临床诊疗。

Objective To evaluate the therapeutic effect and prognosis of preoperative transcatheter arterial chemoembolization (TACE), transcatheter arterial chemoembolization (TAIC), preoperative intravenous chemotherapy for children with advanced stage nephroblastoma. Methods From January 2007 to December 2018, according to different treatment protocols before surgery, children with nephroblastoma were divided into 3 groups, which were TACE group (44 cases), TAIC group (7 cases) and intravenous chemotherapy group (9 cases) in Children′s Hospital, Zhejiang University School of Medicine. The imaging examination, treatment safety and long-term efficacy of these three groups before and after treatment were compared. Observed indicators include tumor debulking rate, envelope integrity rate, necrosis rate, postoperative adverse reactions and follow-up. Results Tumor debulking rate: tumor of TACE group decreased 46.5%, TAIC group shrinked 28.3%, and intravenous chemotherapy group reduced by 23.3%, the difference of tumor shrinkage between TACE group and intravenous chemotherapy group was statistically significant (P<0.05). Tumor necrosis rate: necrotic area in TACE group was about 46.0%-95.4%, average 75.1%±12.5%, while in intravenous chemotherapy group was 65.8%±8.7%, the difference was statistically significant (P<0.01). The tumor membrane integrity rate of these three groups were 86.4%(38/44),5/7 and 6/9 respectively, and difference between TACE group and intravenous chemotherapy group was significant (P<0.05). Patients who had myelosuppression each was 5 in TACE group (5/44), 4 in TAIC group (4/7), and 8 in intravenous chemotherapy group (8/9), and there were significant differences. Follow-up time and tumor-free survival rate in each group were respectively 20 to 92 months (median time 64 months) and 95% in TACE group, 12 to 69 months (median time 30 months) and 43.0% in TAIC group, and 16 to 72 months (median 28 months) and 56.0% in intravenous chemotherapy group. Conclusions Preoperative TACE can lead to tumor shrinkage and necrosis more obviously, systemic adverse reactions are small, also the tumor complete resection rate is higher and the operation is safer.The survival rate can be effectively improved and more suitable for clinical treatment.