Wilimas J A, Magill L, Parham D M, Jerkins G, Kumar M, Douglass E C
Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38101.
Am J Pediatr Hematol Oncol. 1990 Summer;12(2):164-7.
The ability of computed tomographic (CT) criteria to predict the potential for resection with renal salvage in unilateral Wilms' tumor was evaluated retrospectively in 10 children given preoperative treatment for initially inoperable disease. Criteria were (a) tumor involving only one pole and occupying less than one-third of the kidney, (b) functioning kidney, (c) no invasion of collecting system or renal vein, and (d) clear margins between tumor, kidney, and surrounding structures. Review of preoperative CT scans correctly predicted nonsalvageability (as assessed by surgicopathologic findings) in seven cases. Sufficient pathologic data were lacking to confirm positive CT predictors in one case. One patient was rated resectable with salvage on surgicopathologic review, but not by CT criteria, and in one case, a prediction could not be made. The potential for renal salvage may be greater in samples with smaller initial tumor size, and addition of other imaging modalities might enhance the accuracy of prediction. Further studies are needed to assess the feasibility of prospective trials evaluating the risks and benefits of partial nephrectomy in unilateral Wilms' tumor.
回顾性评估了计算机断层扫描（CT）标准对10例接受术前治疗的初发不可切除单侧肾母细胞瘤患儿保留肾脏进行切除可能性的预测能力。标准包括：（a）肿瘤仅累及一个肾极且占肾脏不到三分之一；（b）肾脏有功能；（c）未侵犯集合系统或肾静脉；（d）肿瘤、肾脏及周围结构之间边界清晰。术前CT扫描回顾在7例病例中正确预测了不可保留肾脏（根据手术病理结果评估）。1例病例缺乏足够的病理数据来证实CT阳性预测指标。1例患者经手术病理检查评定可切除并保留肾脏，但CT标准未作出此判断，还有1例病例无法作出预测。初始肿瘤体积较小的病例中保留肾脏的可能性可能更大，增加其他成像方式可能会提高预测准确性。需要进一步研究来评估前瞻性试验的可行性，该试验旨在评估单侧肾母细胞瘤行部分肾切除术的风险和益处。
