儿童肾母细胞瘤临床病理学特征及预后影响因素分析

Analysis of clinicopathological characteristics and prognostic influencing factors of pediatric nephroblastoma

目的:探讨儿童肾母细胞瘤临床病理学特征及相关预后影响因素。方法:回顾性研究我院2017年至2022年收集的34例儿童肾母细胞瘤患者的临床病理资料,并对年龄、性别、发病部位、临床表现、临床分期、病理分型、肿瘤大小、淋巴结转移、脉管癌栓、远处转移、术前化疗等影响儿童肾母细胞瘤预后的相关因素进行单因素(Kaplan-Meier法及log-rank检验)及多因素(COX回归)生存分析。结果:共34例患儿,其中男童16例,女童18例;发病年龄5个月~10岁,中位年龄2岁;71%(24/34)患儿以腹部包块为首发症状,32%(11/34)发生了远处转移,以肺转移最常见;肿瘤直径4.5~20 cm,平均直径10.1 cm,切面灰白色、实性,界限较清楚;镜下主要包括四种组织学类型:混合型13例,上皮型3例,胚芽型14例,间叶型4例;单因素log-rank检验分析结果显示不同临床分期及有无远处转移对肾母细胞瘤的预后有显著影响(P<0.05);而性别、年龄、发病部位、临床表现、病理分型、肿瘤大小、有无淋巴结转移、脉管癌栓、术前是否化疗及手术方式对肾母细胞瘤的预后无显著影响(P>0.05);多因素COX比例风险回归分析结果显示有无远处转移是影响肾母细胞瘤预后的独立危险因素(P<0.05)。结论:肾母细胞瘤是一种高度可愈的儿童恶性肿瘤,早发现、早诊断、早期明确临床分期能够更好的协助临床选择合适的治疗方案;对于临床高分期、远处转移的患儿采取术前化疗有利于提高患儿的预后。

Objective:To investigate the clinicopathological features and prognosis of children with nephroblastoma.Methods:A total of 34 nephroblastoma patients who received treatment at the scond Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2022 were selected for retropectived analysis and Kaplan-Meier method was used to calculate the survival rate and create survival curve.Univariate(Kaplan-Meier test and log-rank test) and multivariate(COX regression) survival analysis were perfored for the factors related to the prognosis of pediatric nephroblastoma,such as age,gender,site of onset,clinical manifestations,clinical stages,pathological classificatim,tumor size,lymph node metastasis vascular embolus,distant metastasis,peroperative chemotherapy.Results:Among the 34 patients,sixteen were males and eighteen were females,and age ranged from five months to ten years(mean 2 years).71%(24/34) had abdominal mass as the first sysptom,32%(11/34) had distant metastasis and lung metastasis was the most common.Tumor size ranged from 4.5 cm to 20 cm(mean 10.1 cm),the cut surface of most tumors was solid and grayish with clear border.Microscopy consisted of four main histologic types:13 cases of mixed,3 cases of epithelial,14 cases of blastemal,and 4 cases of stromal.Clinical stage and metastasis were significantly affected the prognosis of children with nephroblastoma(P<0.05).But it was not significantly affected by gender,age,site of onset,clinical manifestations,pathological classification,tumor size,lymph node metastasis,vascular cancer embolus,preoperative chemotherapy treatment and surgical approach( P > 0.05).Multivariate COX proportional hazards regression analysis showed that metastasis was an independent risk factor for prognosis of nephroblastoma( P < 0.05).Conclusion:Nephroblastoma is a highly curable malignant tumor in children.Early detection,early diagnosis,and early clarification of clinical stage can better assist the clinic in choosing the appropriate treatment plan.For children with high clinical stage and distant metastases,preoperative chemotherapy is beneficial to improve the prognosis of children.