Nephroblastoma in Adults about a Clinical Case

Nephroblastoma is the most common malignant renal tumor in children and is related to an abnormal proliferation of cells resembling those of the embryonic kidney (metanephroma), hence the terminology;embryonal tumor. These are tumors that remain and remain unstudied in Mali because they are common in adults in our context. Its annual incidence is estimated at approximately 1/10,000 births. Nephroblastoma is a rare or even exceptional tumor in adults. The clinical manifestation was a large swelling of the right hypochondrium;abdominal pain for a year;unquantified fever, hypertension, initial hematuria associated with burning during urination and anemia. The main clinical manifestation remained fever and abdominal pain. This renal tumor posed a diagnostic problem which was previously labeled as a mesenteric tumor in our general surgery department. The diagnosis was made by imaging: CT and magnetic resonance imaging. The treatment is multidisciplinary and combines chemotherapy, surgery with or without radiotherapy. The prognosis is poor due to late diagnosis and less effectiveness of chemotherapy compared to the child. Survival did not exceed a year and a half because the renal tumor in our patient was surgically overcome. We report a case of nephroblastoma in an 86-year-old patient with unfavorable histology (hematogenous metastases), operated on in the general surgery department and whose postoperative course was simple and who was referred to oncology for treatment.

Surgical Treatment of Nephroblastoma in a 4-Year Male Child: A Case Report and Literature Review

Herein we report a patient with nephroblastoma which was successfully removed at the Sunyani Teaching Hospital CJ Oppong theatre in Ghana in sub-Saharan Africa by extended below umbilical incision. Our patient had a family history of Wilms tumour predisposing him to the disease. His main symptoms were haematuria and abdominal mass which was noticed later. Examination and investigation were suggestive of a late-stage unilateral Nephroblastoma resulting in the need for nephrectomy. To reduce the need for such radical surgeries among children at an early stage, there is the need for early screening of children for Wilms tumours especially, those with family predisposition as in our case study. The case report presented here constitutes a rare case of nephroblastoma in the literature.

Study on the influence of curcumin on chemosensitivity of nephroblastoma cells

Objective:To study the influence of curcumin on chemosensitivity of nephroblastoma cells.Methods:Human nephroblastoma cells line SK-NEP-1 was transplanted to the nude mice subcutaneously to establish the implantation tumor model of human nephroblastoma cells.A total of 30 tumor-bearing mice were divided into three groups of ten randomly.The routine chemotherapy group was given vincristine(0.05 mg/mL·0.2 mL/d) and actinomycin D(15 ng/mL·0.2 mL/d) combined chemotherapy regime.The curcumin chemotherapy group was given the same combined chemotherapy regimens and curcumin(30 mg/kg/d) by intraperitoneal injection.The control group was given normal saline(NS) of the same volume by intraperitoneal injection.Continuous administration would be kept for 4 weeks and 3 days a week.The volumetric changes of every group were recorded.The serum of every group in different time was collected and the VEGF content was detected by ELISA.All mice were cercrificed and the tumor tissues were stripped and weighed after 4 weeks’ treatment.The tumor inhibition rate was calculated.The cell proliferation activity and apoptosis rate were detected by MTT and flow cytometry method.All data were statistically analyzed by SPSS 19.0.Results:The tumor volume,serum VEGF content,tumor inhibition rate,cell proliferation activity and apoptosis rate of routine chemotherapy group and curcumin chemotherapy group had significant differences comparing with the control group(P<0.05) after 4-week’s treatment.The cancer growth of curcumin chemotherapy group was obviously decreased and even tended to shrink comparing with routine chemotherapy group(χ2=15.732,P=0.007).The cell proliferation activity was significantly reduced and the apoptosis rate was significantly higher,(χ~2=9.427,P=0.012)which showing the effect of chemotherapy was enhanced.Conclusions:The chemosensitivity of nephroblastoma cells could be improved by curcumin,then the effect of preoperative adjuvant chemotherapy scheme would be enhanced,the growth of nephroblastoma cells would be inhibited and the surgical risk of nephroblastoma would be reduced.

Factors of Nephroblastomas’ Relapse in Children at the Academic Hospital Gabriel Toure, Bamako, Mali

Introduction:?The factors of nephroblastomas’ relapse are a set of elements playing a role in the reappearance of cancer cells in the same place of the kidney or in other regions of the body after a 5-year remission.?Objectives:?To determine the frequency and the factors of nephroblastomas’ relapse in the pediatric oncology unit and pediatric surgery of the academic hospital Gabriel Touré. Materials and methods:?This was a retrospective study carried out from January 1, 2005 to December 31, 2019 in all children treated for nephroblastoma relapses in the pediatric oncology unit and in the pediatric surgery service.?Results:?In 15 years, we have managed 182 cases of nephroblastoma, of which 128 cases were declared in complete remission after 5 years and 12 cases presented a recurrence. The relapses factors were: capsular break, intraoperative tumor rupture, presence of an associated malformation, surgery without neoadjuvant chemotherapy and tumor surgical stage (p??0.05). Patients’ age at diagnosis, sex, number of neoadjuvant and adjuvant chemotherapy sessions and histological type were not decisive (p?> 0.05).?Conclusion:?Relapses are more and more frequent in cases of nephroblastoma. The correct use of the protocol would avoid these recurrences.

ULTRASTRUCTURAL CHARACTERISTICS OF NEPHROBLASTOMAS AND THEIR RELATION TO DNA PLOID

Fifty-one cases of nephroblastoma were pathologically studied by light and electron microscopy as well as microspectrophotometry. Under light and electron microscope, the tumor appeared to be carcinosarcoma structurally, consisting of epithelial, sarcomatous and undlfferentiated tumor cells. Their ultrastructural feature was similar to that of renal tubular epithelial cells and tibroblast. It could differentially be diagnosed from renal metoblastic tumors by electron microscopy when the tumor was mainly composed of sarcomatous cells. Microspectrophotometer measurement showed an Increased mean nuclear DNA content (DI>1. 04), belonging to aneuplold tumor, which together with polyploid cells, serving as one of the Important characteristics of malignant tumors. In addition, the poorer the tumor differentiation the higher was the DNA content of the tumor cells, suggesting that the measurement of nuclear DNA of tumor cells might also serve as one of signs to acertain the degree of differentiation and malignant of nephroblastomas with more preciseneas than general morphological examinations.

Prevalence and Prognosis of Relapse of Nephroblastoma at the Pediatric Oncology Unit of Bamako

The nephroblastoma is the third pediatric cancer in Mali, this study aimed to describe the prevalence and prognosis of nephroblastoma relapses. Methods: It was a descriptive retrospective study over a 10-year period from January 2005 to March 2015. We collected children aged 0 to 15 years followed for relapse of nephroblastoma in the pediatric oncology unit of university hospital center (UHC) Gabriel Toure. Results: The frequency of relapse of nephroblastoma was 7.4% (19 cases) whose mean age was 42 months with a sex ratio of 1.3. The relapse occurred before the end of the postoperative course in 16% of cases (3 patients). It was local recurrence in 52% of cases (10 patients), pulmonary 16% (3 patients), and hepatic 11% (2 patients). According to the SIOP classification, 47% of patients were diagnosed in stage III (9 patients) and 21% (4 patients) in stage IV. The tumor was high risk in 37%. Palliative chemotherapy was performed in 63% of the patients (12 patients) and the remaining seven were put on a high risk diet. The overall survival at 5 years was 21% or 4 patients. Conclusion: Our results showed all the difficulties in the management of nephroblastoma relapses in our context.

Early Management of Nephroblastoma: A Single-Center Study in a Sub-Saharan African Country

Introduction: Nephroblastoma is the most common renal cancer in pediatrics. The aim of this study was to describe the epidemiological, clinical, histological characteristics and the immediate outcome of patients with nephroblastoma. Methodology: This was a cross-sectional study of 18 cases of unilateral nephroblastoma, carried out in the pediatric oncology unit (UOP) of the CHU Gabriel Touré from January 2015 to December 2016. Results: The mean age of the patients was 33 months old. The sex ratio was 0.63. The average consultation time was 3 months. A case of malformation syndrome (aniridia and mental retardation) had been observed. The main reason for consultation was abdominal mass (100%) associated with deterioration of general condition (44%), pain (44%) and fever (17%). Stage I accounted for 61% and stage II 39%. The postoperative histological classification made it possible to find the high-risk blastematous type (33%), the regressive type of intermediate risk (11%) and the stromal type of intermediate risk (45%). Toxicities (haematological and digestive) were minimal. The 3-year overall survival was 90%. Conclusion: This study is characterized by the predominance of stages I and II and the fairly large percentage of histology at intermediate risk. These results are above all the result of multidisciplinary collaboration.

Nephroblastoma: Radiological and Pathological Diagnosis of a Case with Liver Metastases

Nephroblastoma is one of the most common causes of abdominal-pelvic mass in children. It still raises a diagnostic problem because of the wide variety of causes of abdominal-pelvic mass but also because of the delays in consultation in sub-Saharan black Africa and consequently the discovery of the mass at a very late and sometimes metastatic stage. Yet nephroblastoma is a very chemo-sensitive malignancy requiring diagnosis at an early stage;a procedure in which medical imaging is essential. We report the case of a large abdominal-pelvic mass in a three-year-old girl in whom the abdominal-pelvic CT allowed to diagnose nephroblastoma with liver metastases. Our objective is to demonstrate the contribution of computed tomography in the diagnosis of large abdominal-pelvic mass of the child and discuss other causes of abdominal-pelvic mass of the child.

Correlation of TGF-β and IGF-1 signaling pathway expression in nephroblastoma tissue with cell proliferation activity and invasion activity

Objective: To study the correlation of TGF-β and IGF-1 signaling pathway expression in nephroblastoma tissue with cell proliferation activity and invasion activity. Methods:Nephroblastoma tumor tissue and adjacent tissue surgically removed in Renmin Hospital of Wuhan University between May 2014 and March 2017 were selected, the expression levels of TGF-β and IGF-1 signal pathway molecules were determined after protein extraction, and the mRNA expression levels of cell proliferation genes and invasion genes were determined after RNA extraction. Results: TGFBR1, IGF1R, p-ERK, Smad2/3 and p-AKT protein expression levels in nephroblastoma tumor tissue were significantly higher than those in adjacent tissue;DNp73, Survivin, Ki-67, TUBB3, MMP2 and N-cadherin mRNA expression levels in nephroblastoma tumor tissue were significantly higher than those in adjacent tissue and positively correlated with TGFBR1, IGF1R, p-ERK, Smad2/3 and p-AKT protein expression levels while Bmi, TAp73, TIMP1, TIMP2 and E-cadherin mRNA expression levels were significantly lower than those in adjacent tissue and negatively correlated with TGFBR1, IGF1R, p-ERK, Smad2/3 and p-AKT protein expression levels. Conclusion: The high expression of TGF-β and IGF-1 signaling pathways in nephroblastoma tissue can promote the proliferation and invasion of tumor cells.

Correlation of nephroblastoma overexpressed gene (NOV) mRNA levels with cell growth- and migration-related gene expression in osteosarcoma tissue

Objective:To study the correlation of nephroblastoma overexpressed gene (NOV) mRNA levels with cell growth- and migration-related gene expression in osteosarcoma tissue. Methods: A total of 78 patients with osteosarcoma undergoing surgical treatment in our hospital between May 2012 and May 2016 were selected, and the osteosarcoma tissue and paracancerous tissue were collected. Fluorescence quantitative PCR method was used to detect the mRNA expression of NOV as well as pro-proliferation/anti-proliferation genes and invasion genes, and the Pearson test was used to further assess the correlation of NOV mRNA expression with the osteosarcoma cell growth and migration activity.Results: NOV mRNA expression in osteosarcoma tissue was significantly lower than that in paracancerous tissue, FoxM1, STIM1 and Orai1 mRNA expression were significantly higher than those in paracancerous tissue, anti-proliferation genes RanBP9, Tap73, Caspase-3, PTEN and P53 mRNA expression were significantly lower than those in paracancerous tissue, and invasion genes EFEMP1, Notch1, Id1 and Src mRNA expression were significantly higher than those in paracancerous tissue. Pearson test showed that the NOV mRNA expression in osteosarcoma tissue was negatively correlated with pro-proliferation genes FoxM1, STIM1 and Orai1 mRNA expression, positively correlated with anti-proliferation genes RanBP9, Tap73, Caspase-3, PTEN and P53 mRNA expression, and negatively correlated with invasion genes EFEMP1, Notch1, Id1 and Src mRNA expression.Conclusion: NOV expression is relatively low in osteosarcoma tissue, and NOV mRNA expression is negatively correlated with tumor cell proliferation and invasion activity.

Experimental study about the regulating effect of Par-4 gene overexpression on the nephroblastoma sensitivity to cisplatin

Objective: To study the regulating effect of Par-4 gene overexpression on the nephroblastoma sensitivity to cisplatin. Methods: Nephroblastoma SK-NEP-1 cells were cultured and divided into four groups, control group were treated with RMPI-1640 without serum or drugs, cisplatin group were treated with serum-free RMPI-1640 containing 5 μg/mL cisplatin, Par-4 group were transfected by Par-4 overexpression plasmids with serum-free RMPI-1640, and cisplatin+ Par-4 group were transfected by Par-4 overexpression plasmid with serum-free RMPI-1640 containing 5 μg/mL cisplatin. The cell proliferation activity as well the expression of apoptosis genes, migration genes and invasion genes was measured. Results: 8 h, 16 h and 24 h after different conditions of treatment, the cell proliferation activity of cisplatin group, Par-4 group and cisplatin + Par-4 group were significantly lower than that of control group, and the cell proliferation activity of cisplatin + Par-4 group was significantly lower than that of cisplatin group and Par-4 group;24 h after different conditions of treatment, Bim, PDCD4, WT1, RGS4, Axin, KAI1, E-cadherin, PPARγ and PTEN mRNA expression in cisplatin group, Par-4 group and cisplatin + Par-4 group were greatly higher than those in control group whereas GDNF, GFRα1, TUBB3, NME1 and FGF1 mRNA expression were greatly lower than those in control group;Bim, PDCD4, WT1, RGS4, Axin, KAI1, E-cadherin, PPARγ and PTEN mRNA expression in cisplatin + Par-4 group were greatly higher than those in cisplatin group and Par-4 group whereas GDNF, GFRα1, TUBB3, NME1 and FGF1 mRNA expression were greatly significantly lower than those in cisplatin group and Par-4 group. Conclusion:Par-4 gene overexpression can increase the nephroblastoma sensitivity to cisplatin, reduce cell proliferation activity, promote apoptosis and inhibit cell migration and invasion.

青蒿琥酯调节AMPK/mTOR/ULK1信号通路对肾母细胞瘤细胞增殖、凋亡和自噬的影响

目的探讨青蒿琥酯对肾母细胞瘤细胞增殖、凋亡和自噬的作用及其分子机制。方法体外培养人肾母细胞瘤细胞株SK-NEP-1并以0、12.5、25.0、50.0、100.0、150.0μmol/L浓度的青蒿琥酯处理,采用CCK-8法测定各组细胞活力并筛选出青蒿琥酯最佳作用浓度。将SK-NEP-1细胞随机分为对照组、青蒿琥酯(100.0μmol/L)组、AMPK抑制剂Dorsomorphin(10.0μmol/L)组、青蒿琥酯(100.0μmol/L)+Dorsomorphin(10.0μmol/L)组,以青蒿琥酯和Dorsomorphin单独或联合处理各组细胞后,采用CCK-8法检测各组细胞活力,采用平板克隆形成实验检测各组细胞的集落形成情况;采用流式细胞术检测各组细胞的凋亡情况;采用MDC荧光染色法检测各组细胞的自噬情况;采用蛋白免疫印迹法检测各组细胞中凋亡相关蛋白[B淋巴细胞瘤-2(Bcl-2)、cleaved多聚ADP核糖聚合酶(PARP)、Bcl-2相关X蛋白(Bax)]、自噬相关蛋白[轻链3(LC3)Ⅱ、LC3Ⅰ、Beclin-1]及AMPK/mTOR/ULK1信号通路相关蛋白的表达情况。结果不同浓度青蒿琥酯均可抑制SK-NEP-1细胞的活力(均P<0.05),且随浓度升高其抑制作用增强。用100.0μmol/L青蒿琥酯和10.0μmol/L Dorsomorphin分别处理SK-NEP-1细胞后,与对照组相比,青蒿琥酯组细胞的凋亡率、自噬空泡相对量及Bax、cleaved PARP、LC3Ⅱ/LC3Ⅰ、Beclin-1、p-AMPK/AMPK、p-ULK1/ULK1蛋白表达水平均升高(均P<0.05),细胞活力、集落形成率及Bcl-2、p-mTOR/mTOR蛋白表达水平均降低(均P<0.05);Dorsomorphin组细胞凋亡率、自噬空泡相对量及Bax、cleaved PARP、LC3Ⅱ/LC3Ⅰ、Beclin-1、p-AMPK/AMPK、p-ULK1/ULK1蛋白表达水平均降低(均P<0.05),细胞活力、集落形成率及Bcl-2、p-mTOR/mTOR蛋白表达水平均升高(均P<0.05)。青蒿琥酯和Dorsomorphin联合干预SK-NEP-1细胞逆转了青蒿琥酯的抗肿瘤作用。结论青蒿琥酯可能通过激活AMPK/mTOR/ULK1信号通路增强肾母细胞瘤细胞自噬,进而抑制其增殖并促进其凋亡。

犬肾脏肾母细胞瘤的病例报告

犬肾脏肾母细胞瘤是一种罕见的恶性肿瘤,常发生于幼年动物,预后谨慎。目前国外报道的此类病例较少,国内报道的此类病例更为罕见。2021年5月中国农业大学动物医院接诊1例犬右肾肾母细胞瘤的病例,手术治疗后患犬生存期为10个月。本文通过论述该病例的诊断和治疗过程,以期为临床上诊疗此类疾病提供一些参考。

基于高通量RNA测序分析Wilms瘤中关键基因对预后及免疫应答的影响

目的探索肾母细胞瘤(WT)中关键基因及其对预后和免疫应答的潜在影响。方法采用高通量RNA测序技术分析临床肿瘤样本和配对正常组织的mRNA全面表达谱,并鉴定差异表达基因。使用GO、KEGG和GSEA富集分析探索差异表达基因在肾母细胞瘤中的潜在生物学功能和机制。使用STRING数据库鉴定HUB基因。LASSO回归用于构建HUB基因预后模型。基于cBioPortal平台分析关键HUB基因的突变特征并对其免疫治疗效果进行预测。采用qPCR验证关键HUB基因的差异表达。结果本研究筛选出1612个差异表达基因,其中1030个上调,582个下调。GO、KEGG或GSEA富集分析显示,差异基因集与细胞周期和免疫应答有关,一定程度上参与了WT的发生发展。基于STRING数据库构建差异基因的PPI网络,进一步确定了10个HUB基因。其中4个HUB基因(TP53、MED1、CCNB1和EGF)被证实与WT患儿的生存密切相关。通过LASSO回归分析构建WT患者的三基因预后签名,根据该签名将患者分为高危或低危组,生存分析显示显著的预后差异(HR=1.814,Log-rank P=0.002)。该模型的3年、5年和7年生存ROC曲线的AUC值均大于0.7。突变分析显示,关键HUB基因整体突变或TP53/CCNB1的单独突变与较低的生存率密切相关,其中TP53高表达与较差的免疫治疗疗效有关。qPCR结果显示,关键HUB基因在肿瘤组织和细胞中呈现出显著的表达差异。结论TP53基因在WT中发挥重要作用,可能成为新的免疫治疗生物标志物和治疗靶点。

基于超声检查、肿瘤细胞因子构建儿童肾母细胞瘤的Nomogram诊断模型

目的:基于超声检查、肿瘤细胞因子构建儿童肾母细胞瘤的Nomogram诊断模型,以提高对肾母细胞瘤的临床诊断效能。方法:选取2019年1月至2023年1月我院收治的82例肾母细胞瘤患儿为研究组,另选取同期82例囊肿性肾病患儿为对照组,均经手术病理证实。术前均行超声检查,比较两组超声特征、临床资料。通过Logistic分析肾母细胞瘤发生的影响因素,根据影响因素构建肾母细胞瘤的Nomogram诊断模型。采用受试者工作特征(ROC)曲线、校准曲线进行Nomogram诊断模型验证。结果:两组肿块性质、内部回声、邻近结构侵犯及转移、伴下腔静脉瘤栓、伴同侧肾静脉血栓、动脉期峰值流速、血流阻力指数、肾体积局部增大、基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)比较,差异有统计学意义(P<0.05);LASSO回归分析显示,可使模型性能优良且影响因素最少的最佳惩罚系数λ下诊断肾母细胞瘤的变量数为6个:即肿块性质、内部回声、邻近结构侵犯及转移、伴同侧肾静脉血栓、VEGF、MMP-9;Logistic回归分析显示,肿块性质、内部回声、邻近结构侵犯及转移、伴同侧肾静脉血栓、VEGF、MMP-9是肾母细胞瘤的相关危险因素(P<0.05);运用R语言绘制肾母细胞瘤诊断模型显示,其C-index为0.939,诊断肾母细胞瘤的AUC为0.939。结论:肿块性质、内部回声、邻近结构侵犯及转移、伴同侧肾静脉血栓、VEGF、MMP-9与肾母细胞瘤发生有关,基于超声检查和肿瘤细胞因子所构建的诊断模型具有较高区分度、校准度以及诊断效能,可为肾母细胞瘤临床诊断提供参考。

血清VEGF、MIP-1α、MVD在不同病理特征肾母细胞瘤患儿中的表达水平

目的:分析血清血管内皮生长因子(VEGF)、巨噬细胞炎性蛋白-1α(MIP-1α)、微血管密度(MVD)在不同病理特征肾母细胞瘤患儿中的表达水平。方法:选取2015年1月至2023年5月该院收治的89例肾母细胞瘤患儿设为观察组,另选取同期该院89名健康体检儿童设为健康组。比较两组及不同病理特征肾母细胞瘤患儿血清VEGF、MIP-1α、MVD水平。结果:观察组血清VEGF、MIP-1α、MVD水平均高于健康组,差异有统计学意义(P<0.05);不同病理特征肾母细胞瘤患儿血清VEGF、MIP-1α、MVD水平比较,Ⅲ~Ⅳ期>I~Ⅱ期,肿瘤破裂>肿瘤未破裂,淋巴结转移>淋巴结未转移,差异均有统计学意义(P<0.05)。结论:肾母细胞瘤患儿血清VEGF、MIP-1α和MVD水平较高且与病理分期、肿瘤破裂情况、淋巴结转移情况等病理特征存在相关性。

基于信息-动机-行为技巧模型的护理干预在肾母细胞瘤患儿中的应用

目的:探讨基于信息-动机-行为技巧(IMB)模型的护理干预在肾母细胞瘤患儿中的应用效果。方法:选取2019年1月-2022年8月收治的肾母细胞瘤患儿60例,采用计算机软件RandA1.0分为对照组(30例)和观察组(30例)。对照组采用常规护理,观察组采用基于IMB模型的护理干预。比较两组患儿家属心理状态、患儿护理依从性、生活质量以及家属护理满意度。结果:干预前,两组焦虑评分、抑郁评分比较,差异无统计学意义(P>0.05);出院当天,两组患儿家长焦虑评分、抑郁评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患儿总依从率高于对照组,差异有统计学意义(P<0.05)。干预前,两组患儿生理功能、心理功能、社会功能以及躯体功能等生活质量指标评分比较,差异无统计学意义(P>0.05);干预一个月,两组患儿各项生活质量指标评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组患儿家长满意度高于对照组,差异有统计学意义(P<0.05)。结论:基于IMB模型的护理干预在肾母细胞瘤患儿中可缓解家长的心理状态,提高患儿护理依从性,改善其生活质量。

Prevention of tumor emboli from the inferior vena cava by the Tempofilter II during resection of nephroblastoma with level III tumor thrombus

The optimal treatment for patients with nephroblastoma and inferior vena cava （IVC） minor thrombus is radical nephrectomy and minor thrombectomv, but the operation for patients with level III tumor thrombus is usually at high risk of puhnonary, embolism （PE）. We report one case of nephroblastoma with level III thrombus in our hospital in 2007, the vena cava tumor thrombectonly was safely performed under the protection of Tempofilter II inferior vena cava filter.

25-羟维生素D与儿童肾母细胞瘤的相关性及对疾病预后的评估价值分析

目的 探讨25-羟维生素D [25-hydroxyvitamin D,25-(OH)D]与儿童肾母细胞瘤的相关性及对疾病预后的评估价值。方法 选取2018年1月—2022年12月收治的肾母细胞瘤患儿50例为肾母细胞瘤组,根据患儿术后病理类型,分为预后良好亚组(38例)和预后不良亚组(12例)。纳入同期体检的健康儿童50例为健康对照组。分析比较各组的血肌酐、25-(OH)D等水平。采用Spearman秩相关分析探讨25-(OH)D与儿童肾母细胞瘤治疗疗效反应的相关性,采用多因素logistic回归分析探讨影响儿童肾母细胞瘤预后的危险因素。结果 肾母细胞瘤组血肌酐、25-(OH)D水平低于健康对照组(P<0.05)。预后不良亚组肿瘤直径、肿瘤分期为Ⅲ~Ⅳ比例、转移比例高于预后良好亚组,血肌酐、25-(OH)D水平低于预后良好亚组(P<0.05)。Spearman秩相关分析显示,血清25-(OH)D水平与儿童肾母细胞瘤治疗疗效反应呈负相关(rs=-0.685,P<0.001)。多因素logistic回归分析显示,肿瘤直径≥10 cm、肿瘤分期为Ⅲ~Ⅳ、存在转移及25-(OH)D<19 ng/mL与儿童肾母细胞瘤预后不良密切相关(P<0.05)。血清25-(OH)D水平评估儿童肾母细胞瘤预后的曲线下面积为0.805 (95%CI:0.706~0.903,P<0.001),约登指数为0.512,最佳截断值为1.764 ng/mL,灵敏度、特异度分别为0.938、0.575。结论 25-(OH)D水平与儿童肾母细胞瘤预后存在显著相关性,可以通过判断25-(OH)D判断预后。

儿童肾母细胞瘤与肾细胞癌的超声图像比较分析

目的 探讨儿童肾母细胞瘤与小儿肾细胞癌的超声声像图表现与差异。方法 回顾性分析2015年5月至2022年4月在该院超声科均进行过术前超声检查,经手术及病理证实的45例儿童肾母细胞瘤(37例)和儿童肾细胞癌(8例)患儿超声声像图表现,并从分析两组肿瘤的发病年龄、大小、内部回声及血流信号来比较肿瘤超声声像图表现的差异。结果 儿童肾母细胞瘤与肾细胞癌两者发病的年龄(P=0.001)、肿瘤大小(P<0.001)差异有统计学意义,部分类型的肾母细胞瘤与肾细胞癌内部图像存在一定差异(P<0.001)。结论 超声医生可根据肿瘤大小及发病年龄的差异,然后结合超声图像,提高对肾母细胞瘤和肾细胞癌的认识。