Haecker Frank-Martin, von Schweinitz Dietrich, Harms Dieter, Buerger Dietrich, Graf Norbert
Division of Pediatric Surgery, University Children's Hospital Basel, PO Box CH-4005 Basel, Switzerland.
J Urol. 2003 Sep;170(3):939-42; discussion 943-4. doi: 10.1097/01.ju.0000073848.33092.c7.
We evaluate results and long-term outcome after partial nephrectomy (PN) for unilateral Wilms tumor (ulWT) in relation to different histological features, performed as initial surgery or after induction chemotherapy (ChT).
Data from patients with ulWT who had undergone PN in the German Study SIOP 93-01/GPOH were analyzed for time of surgery in the treatment schedule, postoperative stage, histological features, surgical radicality and outcome. The results were correlated with overall survival and relapse-free survival, and compared with those of patients who had undergone total tumor nephrectomy (TN).
A total of 770 patients underwent TN and 37 underwent PN, of which 766 (99.5%) and 36 (97.3%), respectively, were radical procedures. A total of 139 TNs and 15 PNs were performed at primary surgery, 630 TNs and 22 PNs after ChT, and 1 TN after irradiation. Two of 15 patients following primary PN and 1 of 22 following delayed PN had local recurrence. Two patients died of metastatic disease. Tumor stage, overall survival of 93% and relapse-free survival of 88% were equal after PN and TN in analysis of the whole group. This was also true for patients with surgery after ChT. One of 2 patients with histologically unfavorable disease had relapse after PN compared to only 3 of 35 patients with histologically low or intermediate risk disease.
PN should be performed only for small, histologically low or intermediate risk tumors after good response to ChT to secure a complete resection.
我们评估了单侧肾母细胞瘤（ulWT）行部分肾切除术（PN）后的结果和长期预后，这些结果与不同的组织学特征相关，PN作为初始手术或在诱导化疗（ChT）后进行。
分析德国SIOP 93-01/GPOH研究中接受PN的ulWT患者的数据，包括治疗计划中的手术时间、术后分期、组织学特征、手术根治性和预后。将结果与总生存率和无复发生存率相关联，并与接受全肿瘤肾切除术（TN）的患者结果进行比较。
共有770例患者接受了TN，37例接受了PN，其中分别有766例（99.5%）和36例（97.3%）为根治性手术。在初次手术时共进行了139例TN和15例PN，ChT后进行了630例TN和22例PN，放疗后进行了1例TN。15例初次PN后的患者中有2例和22例延迟PN后的患者中有1例出现局部复发。2例患者死于转移性疾病。在整个组的分析中，PN和TN后的肿瘤分期、93%的总生存率和88%的无复发生存率相等。ChT后手术的患者也是如此。2例组织学上预后不良的患者中有1例在PN后复发，而35例组织学上低风险或中度风险疾病的患者中只有3例复发。
仅应对ChT反应良好后的小的、组织学上低风险或中度风险的肿瘤进行PN，以确保完整切除。
