D'Angio G J, Evans A E, Breslow N, Beckwith B, Bishop H, Feigl P, Goodwin W, Leape L L, Sinks L F, Sutow W, Tefft M, Wolff J
Cancer. 1976 Aug;38(2):633-46. doi: 10.1002/1097-0142(197608)38:2<633::aid-cncr2820380203>3.0.co;2-s.
The National Wilms' Tumor Study, initiated in 1969, tested competing treatment strategems for patients with tumors ranging from Group (Gp) I (tumors confined to the kidney and totally removed) to Gp IV (remote metastases present at diagnosis). Three hundred and fifty-nine of 606 registered patients were randomized in the trial. Gp I patients under 2 years of age fared well whether postoperative radiation therapy (RT) was or was not added to 15 months' maintenance actinomycin D (AMD). Their prognosis was better than that for older cohorts similarly treated, in whom the difference in relapse rates between treatment groups were suggestive of an RT effect. Combined AMD and vincristine (VCR) gave better results than either agent alone in patients with more advanced tumors (Gps II and III) still confined to the abdomen, all of whom received postoperative RT as well. Preoperative VCR given Gp IV patients in addition to postoperative RT, AMD, and VCR did not improve results. The frequency of mesoblastic nephroma (1%), of bilateral tumors (5%), and of incorrect preoperative diagnosis of Wilms' tumor (5%), the toxicities of the various regimens, and other ancillary data are presented and discussed.
国家肾母细胞瘤研究始于1969年，针对患有从I组（肿瘤局限于肾脏且完全切除）到IV组（诊断时存在远处转移）肿瘤的患者测试了相互竞争的治疗策略。606名登记患者中有359名被随机纳入该试验。I组2岁以下的患者，无论术后放疗（RT）是否添加到15个月的维持性放线菌素D（AMD）治疗中，预后都很好。他们的预后比接受类似治疗的年龄较大队列更好，在年龄较大队列中，治疗组之间的复发率差异提示放疗有效果。在仍局限于腹部的更晚期肿瘤（II组和III组）患者中，联合使用AMD和长春新碱（VCR）比单独使用任何一种药物效果更好，所有这些患者也都接受了术后放疗。除了术后放疗、AMD和VCR外，给IV组患者术前使用VCR并没有改善治疗效果。文中呈现并讨论了中胚叶肾瘤的发生率（1%）、双侧肿瘤的发生率（5%）、肾母细胞瘤术前误诊率（5%）、各种治疗方案的毒性以及其他辅助数据。
