Ora Ingrid, van Tinteren Harm, Bergeron Christophe, de Kraker Jan
Department of Paediatric Haematology and Oncology, Lund University Hospital, 22185 Lund, Sweden.
Eur J Cancer. 2007 Jan;43(1):131-6. doi: 10.1016/j.ejca.2006.08.033. Epub 2006 Nov 2.
The SIOP nephroblastoma clinical trials have previously demonstrated that preoperative chemotherapy is advantageous for patients with nephroblastoma (Wilms' tumour). However, some primary tumours increase in size during preoperative chemotherapy, and to investigate the clinical relevance of this progression we studied the patient cohort with increasing tumours included in the SIOP 93-01 study (June 1993 to June 2000). Patients were considered eligible if they had a confirmed localised Wilms' tumour that had been measured in at least two dimensions at diagnosis and before surgery. Tumour response to preoperative chemotherapy was defined according to criteria set by the World Health Organisation (WHO). Patient characteristics in the different response groups were compared and related to event-free survival and overall survival. Patient records were studied regarding compliance with protocol. Tumour progression during preoperative chemotherapy was observed in 57 of 1090 patients (5%) with localised Wilms' tumours. In those cases, the tumours were significantly smaller at diagnosis and were more often stage III (p=0.05) and associated with high risk histopathology (p=0.03). After adjustment for stage and risk group, progression was proved to be correlated with poorer event-free and overall survival (hazard ratio 1.9, p=0.026 and 3.2, p=0.002 respectively). In summary, progression of localised Wilms' tumours is rarely seen in patients during preoperative chemotherapy. However, independent of stage distribution and histopathological risk group, those whose tumours do increase in size have poorer event-free and overall survival.
国际小儿肿瘤学会（SIOP）的肾母细胞瘤临床试验先前已证明，术前化疗对肾母细胞瘤（威尔姆斯瘤）患者有益。然而，一些原发性肿瘤在术前化疗期间会增大，为了研究这种进展的临床相关性，我们对SIOP 93 - 01研究（1993年6月至2000年6月）中肿瘤增大的患者队列进行了研究。如果患者确诊为局限性威尔姆斯瘤，且在诊断时和手术前至少进行了二维测量，则被认为符合条件。根据世界卫生组织（WHO）设定的标准定义肿瘤对术前化疗的反应。比较不同反应组的患者特征，并将其与无事件生存期和总生存期相关联。研究患者记录以了解是否符合方案。在1090例局限性威尔姆斯瘤患者中，有57例（5%）在术前化疗期间出现肿瘤进展。在这些病例中，肿瘤在诊断时明显较小，更常为Ⅲ期（p = 0.05），且与高风险组织病理学相关（p = 0.03）。在对分期和风险组进行调整后，进展被证明与较差的无事件生存期和总生存期相关（风险比分别为1.9，p = 0.026和3.2，p = 0.002）。总之，术前化疗期间局限性威尔姆斯瘤患者很少出现肿瘤进展。然而，无论分期分布和组织病理学风险组如何，肿瘤确实增大的患者无事件生存期和总生存期较差。
