Division of Pediatric Urology, University of Texas, Dallas, TX, USA.
Pediatr Blood Cancer. 2012 Jun;58(6):898-904. doi: 10.1002/pbc.23240. Epub 2011 Jul 9.
Radical nephrectomy (RN) is the recommended surgical management as part of multi-modality therapy for unilateral Wilms tumor (UWT). Based on recent data demonstrating that renal preserving surgery decreases the likelihood of chronic renal disease and associated co-morbidities, we analyzed oncologic outcomes of patients after partial nephrectomy (PN) for UWT.
We identified all published cases of PN for UWT. Cases of elective PN for UWT were analyzed for tumor stage, presence, timing and location of disease recurrence, and overall survival (OS). Eighty-two patients had adequate data for analysis. For comparison, these endpoints were collected on consecutive children undergoing RN for UWT from 1985 to 2010 at our institution.
Of the 82 PN patients, tumor stage was: I-64, II-10, III-6, IV-2. Of the 121 RN patients, the staging was: I-24, II-45, III-29, IV-23. In the PN group, at a median of 48 months (3-372), the recurrence-free survival (RFS), local RFS and OS were 89.1%, 92.7%, and 95.1%, respectively. In the RN group, at a median of 69 months (0-214), the RFS, local RFS, and OS were 83.1%, 95.0%, and 95.0%, respectively. After controlling for stage, there were no statistically significant differences in the above oncologic outcomes between the groups.
Based on reported data, the oncologic outcomes of PN for UWT in selected patients do not appear to differ from those of RN. PN for appropriately selected patients with UWT should be studied in prospective, co-operative group trials.
根治性肾切除术 (RN) 是单侧肾母细胞瘤 (UWT) 多模式治疗的推荐手术方法。基于最近的数据表明，保留肾单位手术降低了慢性肾脏病和相关合并症的可能性，我们分析了 UWT 患者行部分肾切除术 (PN) 的肿瘤学结果。
我们确定了所有发表的 UWT 行 PN 的病例。对 UWT 行选择性 PN 的病例进行肿瘤分期、疾病复发的存在、时间和位置以及总生存 (OS) 分析。82 例患者有足够的数据进行分析。为了比较，这些终点数据是在我们机构对连续接受 RN 治疗的 UWT 儿童从 1985 年到 2010 年进行收集的。
在 82 例 PN 患者中，肿瘤分期为：I 期 64 例，II 期 10 例，III 期 6 例，IV 期 2 例。在 121 例 RN 患者中，分期为：I 期 24 例，II 期 45 例，III 期 29 例，IV 期 23 例。在 PN 组中，中位随访 48 个月 (3-372 个月)，无复发生存率 (RFS)、局部 RFS 和 OS 分别为 89.1%、92.7%和 95.1%。在 RN 组中，中位随访 69 个月 (0-214 个月)，RFS、局部 RFS 和 OS 分别为 83.1%、95.0%和 95.0%。在校正分期后，两组在上述肿瘤学结果方面无统计学差异。
根据报告的数据，在选定的患者中，PN 治疗 UWT 的肿瘤学结果似乎与 RN 无差异。应在前瞻性、合作组试验中研究为 UWT 患者行 PN 的适当选择。
