CCCG-WT-2016方案治疗43例Wilms肿瘤临床分析

Clinical analysis of Wilms tumors treated with CCCG-WT-2016 regimen in 43 cases

目的总结WT-2016方案治疗Wilms肿瘤的疗效。方法回顾分析2017年3月至2019年3月,采用CCCGWT-2016方案治疗的Wilms肿瘤患儿的临床资料,患儿随访至2020年4月1日,以Kaplan-Meier曲线描述生存结局。结果共纳入43例患儿,男23例、女20例,左侧发病23例、右侧发病19例、双侧发病1例,中位年龄2.40(0.83~2.00)岁。I期7例、II期7例、III期21例、IV期6例、V期2例;病理分型FH型38例、uFH型5例。随访中位时间24.13(17.23~31.10)月,除1例复发患儿需继续强化治疗外,其余患儿已结束治疗。死亡4例(9.3%),2例死于复发、1例死于疾病进展、1例死于脓毒症休克;复发4例(9.3%),3例转移至肺部(其中1例肿瘤原位复发合并肺部转移)、1例转移至纵膈。估计2年总生存率为(93.02±3.89)%,2年无复发生存率为(90.58±4.49)%。总体脓毒症发生率14.0%,呼吸道感染发生率18.6%,药物性肝损害发生率7.0%,4级骨髓抑制发生率39.5%。Ⅳ级骨髓抑制各种不良反应的发生率分别为白细胞降低32.6%,中性粒细胞绝对值降低34.9%,血小板降低23.3%,血红蛋白降低9.3%。结论采用WT-2016方案治疗儿童Wilms肿瘤预后较好。

Objective To summarize the efficacy of WT-2016 regimen in the treatment of Wilms tumor.Methods The clinical data of Wilms tumors treated with CCCG-WT-2016 regimen from March 2017 to April 2019 were retrospectively analyzed.The children were followed up until April 1,2020,and survival outcomes were described by Kaplan-Meier method.Results A total of 43 children(23 boys and 20 girls)were included,with a median age of 2.40(0.83~2.00)years.The left,right and bilateral sides were affected in 23,19 and 1 patients respectively.There were 7 cases of stageⅠ,7 cases of stageⅡ,21 cases of stageⅢ,6 cases of stageⅣand 2 cases of stageⅤ.The pathological classification results were 38 cases of favorable histology(FH)type and 5 cases of unfavorable histology(uFH)type.The median follow-up of all patients was 24.13(17.23~31.10)months.Except 1 relapsed child who needed further intensive treatment,the rest of the children had completed the treatment.There were 4 deaths(9.3%),of which 2 were due to recurrence,1 due to disease progression and 1 due to septic shock.There were 4 cases of recurrence(9.3%),including 3 cases of metastasis to the lungs(1 case of in-situ tumor recurrence with pulmonary metastasis)and 1 case of metastasis to the mediastinum.Estimated 2-year overall survival(OS)and progressionfree survival(PFS)was(93.02±3.89)%and(90.58±4.49)%respectively for all patients.The overall incidence of sepsis,respiratory infection,drug-induced liver injury and grade 4 myelosuppression were 14.0%,18.6%,7.0%,and 39.5%consecutively.The adverse reactions of grade 4 myelosuppression were the decreases in leukocytes by 32.6%,neutrophils absolute value by 34.9%,,platelets by 23.3%and hemoglobin by 9.3%.Conclusion WT-2016 regimen has improved the prognosis of children with Wilms tumor.