Brisse Hervé J, Schleiermacher Gudrun, Sarnacki Sabine, Helfre Sylvie, Philippe-Chomette Pascale, Boccon-Gibod Liliane, Peuchmaur Michel, Mosseri Véronique, Aigrain Yves, Neuenschwander Sylvia
Department of Radiology, Curie Institute, Paris, France.
Cancer. 2008 Jul 1;113(1):202-13. doi: 10.1002/cncr.23535.
According to current International Society of Pediatric Oncology (SIOP) Wilms recommendations, all preoperative tumor ruptures should be classified as stage IIIc. However, to the authors' knowledge, the definition and diagnostic criteria of preoperative rupture have not been defined clearly.
The authors performed a retrospective analysis of 57 children with clinical and/or radiologic (computed tomography [CT]) signs of preoperative tumor rupture of a series of 250 patients enrolled in Wilms SIOP protocols at their institution.
Clinical and radiologic signs of preoperative rupture were observed in 39 patients and 55 patients, respectively. The site of rupture on imaging was retroperitoneal only in 48 patients and both retroperitoneal and intraperitoneal in 7 patients. Surgery was performed after chemotherapy in 55 of 57 patients. Peritoneal disease recurrence occurred in 3 of 57 patients, including 2 patients with stage III tumors who had initial intraperitoneal rupture and 1 patient with a stage I tumor. Among the 48 patients who had radiologic signs of retroperitoneal-only rupture, the final pathologic stage was stage III in 22 patients, stage II in 9 patients, and stage I in 17 patients, and no abdominal disease recurrence was observed, although only 23 of 48 patients received flank radiotherapy. The 5-year local control rate was significantly higher in patients who had retroperitoneal-only rupture compared with patients who had intraperitoneal rupture (100% vs 83.3%; standard error, +/-15.2%; P = .0015).
The use of CT scans significantly increased the number of patients who could be classified with "tumor rupture." Intraperitoneal rupture was diagnosed accurately with CT and was associated with a significant risk of peritoneal disease recurrence. In contrast, patients who have radiologic signs of localized retroperitoneal-only rupture at diagnosis most likely should not be upstaged, and their treatment may be determined according to pathologic stage only.
根据当前国际小儿肿瘤学会（SIOP）关于肾母细胞瘤的建议，所有术前肿瘤破裂均应归类为Ⅲc期。然而，据作者所知，术前破裂的定义和诊断标准尚未明确界定。
作者对其机构纳入Wilms SIOP方案的250例患者中的57例有术前肿瘤破裂临床和/或放射学（计算机断层扫描[CT]）征象的儿童进行了回顾性分析。
分别在39例和55例患者中观察到术前破裂的临床和放射学征象。影像学上破裂部位仅位于腹膜后的有48例患者，腹膜后和腹腔内均有的有7例患者。57例患者中有55例在化疗后进行了手术。57例患者中有3例发生腹膜疾病复发，包括2例Ⅲ期肿瘤患者，最初为腹腔内破裂，1例Ⅰ期肿瘤患者。在48例仅有腹膜后破裂放射学征象的患者中，但48例患者中只有23例接受了侧腹放疗，最终病理分期为Ⅲ期的有22例患者，Ⅱ期的有9例患者，Ⅰ期的有17例患者，未观察到腹部疾病复发。仅有腹膜后破裂的患者5年局部控制率显著高于有腹腔内破裂的患者（100%对83.3%；标准误差，±15.2%；P = 0.0015）。
CT扫描的应用显著增加了可归类为“肿瘤破裂”的患者数量。CT能准确诊断腹腔内破裂，且与腹膜疾病复发的显著风险相关。相比之下，诊断时仅有局限性腹膜后破裂放射学征象的患者很可能不应提高分期，其治疗可仅根据病理分期确定。
