肾母细胞瘤复发危险因素分析

Relapsing risk factors for Wilms tumor

目的分析肾母细胞瘤患儿的临床特征、监测手段,探讨其复发的危险性因素。方法收集2014年1月至2020年1月复旦大学附属儿科医院肿瘤外科收治的肾母细胞瘤患儿152例的临床资料,其中在复旦大学附属儿科医院肿瘤外科初诊并按COG治疗体系接受手术治疗的141例中,男78例,女63例,初诊时中位年龄为29个月,年龄范围为3个月至9岁,其余11例为在外院术后发现复发来本院就诊。使用软件SPSS 26.0版本,采用Kaplan-Meier和Logrank检验对其无复发生存情况进行分析,进行单因素筛选,将其中P<0.15的因素进行多因素COX回归分析,从而发现可能与复发相关的独立危险因素。收集复发患儿初次手术术后化疗方案及药物、复发的监测手段及时间。采用分层Fisher精确检验分析术后化疗药物对复发的影响。计划内定期规律随访,通过B型超声、CT、MRI等影像学监测复查。结果141例中16例患儿复发,单因素筛选中具有统计学意义的因素有性别(P=0.024)、年龄(P=0.014)、淋巴结状态(P=0.009)以及是否进行活检(P=0.030),多因素COX回归显示淋巴结阳性状态与活检情况是复发的高风险因素。具有详细化疗方案记录的患儿中,在控制了淋巴结状态影响后,使用长春地辛替代长春新碱进行术后化疗对患儿的复发有影响。复旦大学附属儿科医院肿瘤外科16例及外院11例复发患儿中,4例通过出现临床症状、体征发现复发,发现复发的中位时间为19个月,其余患儿发现复发时并未出现临床症状,而是通过定期随访影像学检查发现,其从诊断到发现复发的中位时间更短。总体中位随访时间33个月,平均为36.3个月,能够早期发现超过80%的无症状复发。结论患儿淋巴结阳性及进行了开放活检是复发的独立危险因素,计划内的随访复查能够早期发现复发。

Objective To explore the clinical characteristics and monitoring modalities of Wilms tumor(WT)and to examine the risk factors for its recurrence in children.Methods From January 2014 to January 2020,a total of 152 children with nephroblastoma(NB)were recruited.Among them,141 children were initially diagnosed and operated.There were 78 boys and 63 girls with a median age of initial diagnosis at 29(3-108)months.SPSS version 26.0 was employed for statistical analysis.Kaplan-Meier and Log-rank were utilized for examining recurrence-free survival.In univariate analysis,factors with P<0.15 were included for multivariate cox regression.The effect of postoperative chemotherapeutic agents on recurrence was evaluated by Fisher's exact test.Post-discharge follow-ups were conducted through ultrasonography,computed tomography(CT)and magnetic resonance imaging(MRI).Results There were 16 relapsing cases(13.33%).Biopsy(P=0.030),gender(P=0.024),age(P=0.014)and lymph node status(P=0.009)differed significantly according to univariate analysis.Lymph node positivity and biopsy were independent risk factors for relapse according to multivariate cox regression.In those with a record of chemotherapeutic regimens,dosing of vindesine rather than vincristine for postoperative chemotherapy after controlling the effect of lymph node status had an impact on relapse.Among 16 children with recurrence at our hospital and 11 at other hospitals,4 relapsing cases were detected through clinical symptoms.The median time of relapse was 19 months.The remainders were found through regular follow-up imaging examinations.The median time from diagnosis to detection of recurrence was shorter.Median follow-up period was 33 months and mean follow-up period 36.3 months.Planned follow-up re-examinations could detect more than 80%of asymptomatic recurrence.Conclusions Positive lymph nodes and open biopsy are independent risk factors for recurrence.Planned follow-up re-examinations may detect recurrence early.