Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Cancer. 2012 May;48(7):1060-5. doi: 10.1016/j.ejca.2011.05.025. Epub 2011 Jun 22.
The SIOP 2001 nephroblastoma study hypothesised that patients with 'CT-only' pulmonary nodules would have the same outcome as patients with localised disease of same stage and histology.
Unilateral Wilms' tumour (WT) patients, who had chest CT scans at diagnosis showing any sized pulmonary nodules undetected on chest X-ray, between November 2001 and November 2009, were selected from the SIOP 2001 database.
Among 2532 WT patients, 103 unilateral nephroblastoma patients with CT-only lung lesions were found. Thirty-seven patients received preoperative treatment according to the localised-disease protocol, and 66 according to the metastatic-disease protocol. The 3-year event-free survival (EFS) was 70% (95% CI: 55-89%) and 77% (95% CI: 66-89%), respectively. Corresponding 3-year overall survival (OS) was 89% (95% CI: 77-100%) and 85% (95% CI: 75-96%), respectively (p-value not significant). EFS and OS of all 2071 patients with true localised disease were 87% (95% CI: 86-89%) and 96% (95% CI: 94-97%), respectively. Patients with metastatic disease (n = 358) had 3-year EFS and OS estimates of 68% (95% CI: 63-74%) and 77% (95% CI: 72-82%), respectively.
EFS and OS of patients with CT-only lung lesions were inferior to that of true localised-disease patients and superior to that of patients with metastatic disease. However, no significant difference was found in EFS and OS between CT-only patients treated for localised or metastatic disease. The clinician's preference to treat patients with CT-only pulmonary nodules as metastatic disease is not evidence-based. Chest CT at diagnosis does not improve outcome but presents paediatric oncologists with a difficult dilemma.
SIOP 2001 肾母细胞瘤研究假设，在 CT 仅发现肺部结节的患者中，其结局与具有相同分期和组织学的局限性疾病患者相同。
2001 年 11 月至 2009 年 11 月期间，从 SIOP 2001 数据库中选择单侧 Wilms 肿瘤（WT）患者，其胸部 CT 扫描显示胸部 X 线检查未发现任何大小的肺部结节。
在 2532 例 WT 患者中，发现 103 例单侧肾母细胞瘤患者存在 CT 仅肺部病变。37 例患者根据局限性疾病方案接受术前治疗，66 例患者根据转移性疾病方案接受治疗。3 年无事件生存率（EFS）分别为 70%（95%CI：55-89%）和 77%（95%CI：66-89%）。相应的 3 年总生存率（OS）分别为 89%（95%CI：77-100%）和 85%（95%CI：75-96%）（无显著差异）。2071 例真正局限性疾病患者的 3 年 EFS 和 OS 分别为 87%（95%CI：86-89%）和 96%（95%CI：94-97%）。358 例转移性疾病患者的 3 年 EFS 和 OS 估计值分别为 68%（95%CI：63-74%）和 77%（95%CI：72-82%）。
CT 仅肺部病变患者的 EFS 和 OS 低于真正局限性疾病患者，高于转移性疾病患者。然而，CT 仅肺部病变患者的 EFS 和 OS 局部或转移性疾病治疗之间无显著差异。临床医生将 CT 仅肺部结节患者视为转移性疾病进行治疗的做法并无依据。诊断时的胸部 CT 并不能改善结局，但给儿科肿瘤医生带来了一个困难的困境。
