Bogaert Guy A, Heremans Birgit, Renard Marleen, Bruninx Liesje, De Wever Liesbeth, Van Poppel Hendrik
University Hospital Gasthuisberg, Gasthuisberg, Belgium.
J Urol. 2009 Oct;182(4 Suppl):1869-74. doi: 10.1016/j.juro.2009.03.022. Epub 2009 Aug 18.
A conclusion of Société Internationale d'Oncologie Pédiatrique in 2001 after protocol 2, 5, 6, 9 and 93-01 was that "preoperative chemotherapy would make nephrectomy easier and furthermore, metastases may disappear or become resectable and vascular extension may regress and partial nephrectomy may become possible." We changed our strategy from preoperative chemotherapy in select cases only to standard 4 to 6-week preoperative chemotherapy in all. However, it appears dubious whether surgical ease or perioperative complications consistently improved after preoperative chemotherapy. We investigated volume changes after chemotherapy and compared all possible variables at a single center using the same surgical team.
A total of 32 children with Wilms tumor between 1998 and 2007 were included in a retrospective analysis, including 15 without preoperative chemotherapy according to the National Wilms' Tumor Study Group protocol before 2001 and 17 with preoperative chemotherapy according to the Société Internationale d'Oncologie Pédiatrique 2001 protocol. We studied the change in tumor volume using picture archive and communication systems volume measurement after chemotherapy, surgical procedure parameters (child body mass index, length and type of incision, blood loss, operative time, hospital stay, pain medication and complications) and outcome (histology and staging). Statistical analysis was performed using the t, Fisher and chi-square tests.
The 2 groups were comparable in gender, age (mean 5.4 and 3.9 years, respectively) and staging at diagnosis. At diagnosis mean +/- SD Wilms tumor volume was 408.93 +/- 387.39 and 454.58 +/- 236.71 cm(3) in the nonchemotherapy and chemotherapy groups, respectively. In the chemotherapy group 12 of 17 tumors decreased a mean of 60.9% +/- 24.6% and 5 of 17 increased 42.8% +/- 31.3%. No analyzed parameters were different in the 2 groups.
Our single center analysis with the same surgical team before and after the preoperative chemotherapy era show that it remains unpredictable whether surgery in a child with Wilms tumor is safer and easier after preoperative chemotherapy.
国际小儿肿瘤学会在2001年对方案2、5、6、9和93 - 01进行总结后得出结论：“术前化疗会使肾切除术更容易，此外，转移灶可能消失或变得可切除，血管侵犯可能消退，部分肾切除术也有可能实现。”我们将策略从仅在部分病例中进行术前化疗改为对所有病例进行标准的4至6周术前化疗。然而，术前化疗后手术操作是否更简便或围手术期并发症是否持续改善仍不明确。我们研究了化疗后的体积变化，并由同一手术团队在单一中心比较了所有可能的变量。
对1998年至2007年间共32例患有肾母细胞瘤的儿童进行回顾性分析，其中15例根据国家肾母细胞瘤研究组2001年前的方案未接受术前化疗，17例根据国际小儿肿瘤学会2001年方案接受术前化疗。我们使用图像存档与通信系统体积测量法研究化疗后肿瘤体积的变化、手术操作参数（儿童体重指数、切口长度和类型、失血量、手术时间、住院时间、止痛药物使用和并发症）以及结果（组织学和分期）。使用t检验、Fisher检验和卡方检验进行统计分析。
两组在性别、年龄（分别为平均5.4岁和3.9岁）以及诊断时的分期方面具有可比性。诊断时，未化疗组和化疗组肾母细胞瘤的平均体积±标准差分别为408.93±387.39和454.58±236.71 cm³。在化疗组中，17个肿瘤中有12个平均缩小了60.9%±24.6%，17个中有5个增大了42.8%±31.3%。两组中分析的参数没有差异。
我们在术前化疗时代前后由同一手术团队进行的单中心分析表明，肾母细胞瘤患儿术前化疗后手术是否更安全、更简便仍无法预测。
