小儿肾母细胞瘤患者淋巴结受累情况及取样数量与其预后的关系

The relationship between lymph node involvement,sampling quantity and prognosis in pediatric patients with nephroblastoma

目的分析小儿肾母细胞瘤(WT)患者淋巴结受累情况及取样数量与其预后的关系。方法收集2010年9月至2018年5月我院收治的WT患儿157例,分析患儿淋巴结受累情况及取样数量对5年无事件生存率(EFS)的影响。结果淋巴结受累患儿5年EFS为50.00%(10/20),淋巴结未受累患儿5年EFS为87.59%(120/137),淋巴结未受累患儿5年EFS明显高于淋巴结受累患儿(P<0.05);在不同病理类型亚组中,淋巴结受累的预后不良型(uFH)患儿生存情况明显低于预后良好型(FH)患儿(P<0.05);未受累患儿的淋巴结取样数量中位数为3个(0~18个),淋巴结受累患儿取样数量的中位数为9个(2~23个)。当术中取样超过7个时检出阳性淋巴结的概率越高,当术中取样数量在10个及以上时,淋巴结阳性率无明显增加。不同病理类型、术前是否进行化疗的WT患儿术中淋巴结取样数量比较,差异无统计学意义(P>0.05),而不同临床分期的WT患儿术中取样数量比较,差异有统计学意义(P<0.05);存在13.46%的Ⅰ期患儿及27.14%的Ⅱ期患儿术中采集淋巴结数量达到7个及以上,而40.00%的Ⅲ期患儿术中采集至少7个淋巴结。不同取样数量的Ⅱ、Ⅲ期WT患儿5年EFS比较,差异无统计学意义(P>0.05)。结论淋巴结受累是导致WT患儿预后不良的重要因素,而淋巴结取样数量对患儿预后不具有独立预测价值,当取样超过7个时检出阳性淋巴结的概率大大提升。

Objective To analyze the relationship between lymph node involvement,the number of samples and prognosis in children with Wilms tumor(WT).Methods The clinical data of 157 children with WT admitted from September 2010 to May 2018 were collected.The effects of lymph node involvement and the number of samples on 5-year event-free survival(EFS)were analyzed.Results The 5-year EFS in WT children with lymph node involvement was 50.00%(10/20).The 5-year EFS in WT children without lymph node involvement was 87.59%(120/137).The 5-year EFS in children without lymph nodes involvement was significantly longer than that children with lymph node involvement(P<0.05).In the subgroups of different pathological types,the in-fluence of lymph node involvement on the prognosis of children with unfavorable histology(uFH)was significantly greater than that of children with favorable histology(FH)(P<0.05).The median number of lymph nodes sampled was 3(0~18)in children without lymph node involvement and 9(2-23)in children with lymph node involvement.When more than 7 lymph nodes were sampled during the operation,the probability of positive lymph nodes was higher.When the number of intraoperative sampling was 10 or more,the positive rate of lymph nodes was not significantly increased.In different pathological type,there was no statistically significant difference in the number of lymph node samples taken during surgery whether WT children undergoing chemotherapy before surgery(P>0.05).There were significant differences in the number of intraoperative sampling in WT children with different clinical stages(P<0.05).The lymph node numbers were 7 and above in 13.46%stage children and 27.14%of stage Ⅱ children during intraoperative collection,while at least 7 lymph nodes in 40.00%of stage Ⅱ period during intraoperative collection.There was no sig-nificant difference in 5-year EFS rate between stage Ⅱand Ⅲ WT children with different sample numbers(P>0.05).Conclusions Lymph node involvement is an important factor leading to poor prognosis in children with WT.The number of lymph nodes sampled has no independent predictive value for the prognosis of children with WT.When the number of lymph nodes sampled is more than 7,the probability of positive lymph nodes is greatly increased.