化疗对于肾母细胞瘤肺转移灶的疗效观察

Therapeutic effect of chemotherapy on lung metastases of nephroblastoma

目的观察肾母细胞瘤(WT)肺转移灶的转归,探讨不同化疗方案的疗效。方法回顾性分析2012年至2020年就诊并规律随访的WT肺转移患儿的临床资料,分析肿瘤肺转移灶对不同化疗的应答差异。结果20例WT肺转移患儿,男11例、女9例,中位年龄38.0(20.0~5.8)月;其中预后良好型17例,预后不良型3例;单肺转移13例,双肺转移7例;初诊时肿瘤分期Ⅰ期1例,Ⅱ期5例,Ⅲ期3例,Ⅳ期9例,2例患儿外院首诊分期不明;12例术前发现肺转移,8例术后发现;合并其他远处转移者8例;化疗后转移应答为8例完全缓解,4例部分缓解,4例稳定,4例进展。采用有序logistic回归分析进行多因素分析,结果显示化疗方案CCCG-WT-2016的偏回归系数为-2.05,并呈现出0.05检验水准的显著性(Z=-2.03,P=0.043),采用CCCG-WT-2016方案化疗患儿的肺转移灶转移应答优于NWTS-5方案。结论采用WT-2016方案化疗的患儿转移应答明显优于采用NWTS-5方案化疗的患儿。

Objective To observe the outcome of lung metastases in Wilms’tumor(WT)and to explore the efficacy of different chemotherapy regimens.Methods The clinical data of WT children with lung metastases who were treated and followed up regularly from 2012 to 2020 were retrospectively analyzed to explore the difference in response to different chemotherapy regimens.Results There were 20 WT children(11 boys and 9 girls)with lung metastases,and the median age was 38.0(5.8~20.0)months.There were 17 cases of favorable histology(FH)type and 3 cases of unfavorable histology(UFH)type.Single lung metastasis was found in 13 cases and bilateral lung metastases were in 7 cases.At the initial diagnosis,1 case was diagnosed as stageⅠ,5 cases as stageⅡ,3 cases as stageⅢand 9 cases as stageⅣ.Two cases were first diagnosed in other hospitals with unknown stage.Lung metastases were found preoperatively in 12 cases and postoperatively in 8 cases.Eight cases were complicated with other distant metastases.After chemotherapy,the metastatic response was complete remission in 8 cases,partial remission in 4 cases,stable in 4 cases and progressive in 4 cases.Ordered logistic regression analysis was used for multivariate analysis.The results showed that the partial regression coefficient of CCCG-WT-2016 chemotherapy regimen was-2.05,presenting significance at the test level of 0.05(Z=-2.03,P=0.043).It was suggested that CCCG-WT-2016 regimen was superior to NWTS-5 regimen in lung metastasis response.Conclusions The objective response in children treated with CCCG-WT-2016 regimen was significantly better than that of children treated with NWTS-5 regimen.