Graf N, Tournade M F, de Kraker J
Department of Pediatrics, Universitätsklinik für Kinder- und Jugendmedizin, Homburg, Germany.
Urol Clin North Am. 2000 Aug;27(3):443-54. doi: 10.1016/s0094-0143(05)70092-6.
More than 25 years after introducing preoperative chemotherapy for Wilms' tumor, the benefits of this approach are well known. The preoperative protocol results in easier operations with significantly fewer tumor ruptures during surgery and a favorable stage distribution. Acute toxicity and late effects are minimized without jeopardizing disease-free and overall survival. Future clinical trials of Wilms' tumor should seek additional risk factors to stratify and individualize treatment. These prognostic factors will improve the cure rates for high-risk patients by intensifying therapy and the quality of life for children with more favorable prognosis by lowering therapy to a minimum. As is true for radical surgery, partial nephrectomy in unilateral disease must be evaluated in carefully selected patients according to clear and well-defined indications. Molecular genetic studies should increase understanding of Wilms' tumor, influencing treatment and outcome.
在将术前化疗引入肾母细胞瘤治疗25年多后，这种治疗方法的益处已广为人知。术前方案可使手术更轻松，术中肿瘤破裂显著减少，且分期分布有利。急性毒性和远期影响降至最低，同时不影响无病生存率和总生存率。未来肾母细胞瘤的临床试验应寻找更多风险因素，以实现治疗的分层和个体化。这些预后因素将通过强化治疗提高高危患者的治愈率，并通过将治疗降至最低限度来改善预后较好儿童的生活质量。与根治性手术一样，对于单侧疾病的部分肾切除术，必须根据明确且定义良好的指征，在精心挑选的患者中进行评估。分子遗传学研究应增进对肾母细胞瘤的了解，从而影响治疗和预后。
