Wang Hsin-Hsiao S, Abern Michael R, Cost Nicholas G, Chu David I, Ross Sherry S, Wiener John S, Routh Jonathan C
Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Urology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
J Urol. 2014 Oct;192(4):1196-202. doi: 10.1016/j.juro.2014.04.003. Epub 2014 Apr 13.
Nephron sparing surgery is the standard of care for many adults with renal tumors and has been described in some children with Wilms tumor. However, beyond case series the data concerning nephron sparing surgery application and outcomes in patients with Wilms tumor are scarce. We examined nephron sparing surgery outcomes and factors associated with its application in children with Wilms tumor.
We retrospectively reviewed the 1998 to 2010 SEER database. We identified patients 18 years old or younger with Wilms tumor. Clinical, demographic and socioeconomic data were abstracted, and statistical analysis was performed using multivariate logistic regression (predicting use of nephron sparing surgery limited to unilateral tumors smaller than 15 cm) and Cox regression (predicting overall survival) models.
We identified 876 boys and 956 girls with Wilms tumor (mean ± SD age 3.3 ± 2.9 years). Of these patients 114 (6.2%) underwent nephron sparing surgery (unilateral Wilms tumor in 74 and bilateral in 37). Median followup was 7.1 years. Regarding procedure choice, nephron sparing surgery was associated with unknown lymph node status (Nx vs N0, p <0.001) and smaller tumor size (p <0.001). Regarding survival, only age (HR 1.09, p = 0.002), race (HR 2.48, p = 0.002), stage (HR 2.99, p <0.001) and lymph node status (HR 2.17, p = 0.001) predicted decreased overall survival. Survival was not significantly different between children undergoing nephron sparing surgery and radical nephrectomy (HR 0.79, p = 0.58).
In children with Wilms tumor included in the SEER database nephron sparing surgery has been infrequently performed. Nephron sparing surgery application is associated with smaller, bilateral tumors and with omission of lymphadenectomy. However, there are no evident differences in application of nephron sparing surgery based on demographic or socioeconomic factors. Despite lymph node under staging, overall survival is similar between patients undergoing nephron sparing surgery and radical nephrectomy.
保留肾单位手术是许多成年肾肿瘤患者的标准治疗方法，在一些患肾母细胞瘤的儿童中也有相关报道。然而，除了病例系列研究外，关于肾母细胞瘤患者保留肾单位手术的应用情况及预后的数据很少。我们研究了保留肾单位手术在肾母细胞瘤患儿中的预后情况以及与该手术应用相关的因素。
我们回顾性分析了1998年至2010年的监测、流行病学与最终结果（SEER）数据库。我们确定了年龄在18岁及以下的肾母细胞瘤患者。提取了临床、人口统计学和社会经济数据，并使用多变量逻辑回归（预测仅限于单侧肿瘤小于15厘米时保留肾单位手术的使用情况）和Cox回归（预测总生存率）模型进行统计分析。
我们确定了876例患肾母细胞瘤的男孩和956例女孩（平均年龄±标准差为3.3±2.9岁）。在这些患者中，114例（6.2%）接受了保留肾单位手术（74例为单侧肾母细胞瘤，37例为双侧）。中位随访时间为7.1年。关于手术选择，保留肾单位手术与淋巴结状态未知（Nx对比N0，p<0.001）以及肿瘤较小（p<0.001）有关。关于生存率，只有年龄（风险比[HR]1.09，p = 0.002）、种族（HR 2.48，p = 0.002）、分期（HR 2.99，p<0.001）和淋巴结状态（HR 2.17，p = 0.001）可预测总生存率降低。接受保留肾单位手术和根治性肾切除术的儿童之间的生存率无显著差异（HR 0.79，p = 0.58）。
在SEER数据库纳入的肾母细胞瘤患儿中，保留肾单位手术的实施频率较低。保留肾单位手术的应用与较小的双侧肿瘤以及未进行淋巴结清扫有关。然而，基于人口统计学或社会经济因素，保留肾单位手术的应用并无明显差异。尽管存在淋巴结分期不足的情况，但接受保留肾单位手术和根治性肾切除术的患者总生存率相似。
