Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Urology, University of Colorado School of Medicine and the Children's Hospital Colorado, Aurora, CO.
Department of Pediatric Surgery and Urology, Silesian Piasts University of Medicine, Wroclaw, Poland.
Urology. 2014 Jun;83(6):1388-93. doi: 10.1016/j.urology.2014.01.051. Epub 2014 Apr 24.
To better understand the impact of nephron-sparing surgery (NSS) on renal function in patients with nonsyndromic unilateral Wilms tumor (uWT), a group of such patients treated with NSS were compared with a stage-matched cohort managed with radical nephrectomy (RN). The recommended management of nonsyndromic uWT is RN. However, NSS may decrease the risk of long-term renal disease and associated comorbidities.
An international, multi-institutional review was conducted of nonsyndromic uWT cases managed with NSS and compared with a stage-matched RN cohort. Data were collected on demographics, oncologic characteristics and outcomes, serum creatinine, and estimated glomerular filtration rate (eGFR) calculated via Schwartz formula.
Fifteen patients who underwent NSS (6 females and 9 males) met study criteria and were diagnosed at a median age of 2.5 years (range, 0.2-8.2 years) and followed for a median of 8.4 years (range, 0.5-31.8 years). The stage-matched RN cohort consisted of 15 patients (8 females and 7 males) diagnosed at a median age of 3.7 years (0.3-7.4) and followed for a median of 2.1 years (0.6-10.5 years). The median preoperative eGFR was 91.7 (39.4-237.7) and 149.9 (93.8-215.9) for NSS and RN, respectively, P=.026. The median eGFR at last follow-up was 135.3 (57.5-185.8) and 131.0 (98.6-161.2) for NSS and RN, respectively, P=.95. The median change in eGFR during the study period was a gain of 28.6 (-51.9 to 83.0) for the NSS cohort vs a loss of 19.1 (-54.7 to 25.2) for the RN cohort, P=.007.
In a highly selected patient population with nonsyndromic uWT, NSS provides excellent renal function preservation when compared with RN. These data require validation via prospective investigation on a larger scale.
更好地了解保肾手术（NSS）对非综合征单侧肾母细胞瘤（uWT）患者肾功能的影响，将一组接受 NSS 治疗的此类患者与接受根治性肾切除术（RN）治疗的分期匹配队列进行比较。非综合征性 uWT 的推荐治疗方法是 RN。然而，NSS 可能会降低长期肾病和相关合并症的风险。
对接受 NSS 治疗的非综合征性 uWT 病例进行了国际多机构回顾性研究，并与分期匹配的 RN 队列进行了比较。收集了人口统计学、肿瘤学特征和结果、血清肌酐和 Schwartz 公式计算的估算肾小球滤过率（eGFR）数据。
15 名接受 NSS（6 名女性和 9 名男性）的患者符合研究标准，中位年龄为 2.5 岁（范围，0.2-8.2 岁），中位随访时间为 8.4 年（范围，0.5-31.8 年）。分期匹配的 RN 队列由 15 名患者（8 名女性和 7 名男性）组成，中位诊断年龄为 3.7 岁（0.3-7.4 岁），中位随访时间为 2.1 年（0.6-10.5 年）。NSS 和 RN 的术前中位 eGFR 分别为 91.7（39.4-237.7）和 149.9（93.8-215.9），P=.026。NSS 和 RN 的末次随访中位 eGFR 分别为 135.3（57.5-185.8）和 131.0（98.6-161.2），P=.95。NSS 组研究期间 eGFR 的中位变化为增加 28.6（-51.9 至 83.0），而 RN 组为减少 19.1（-54.7 至 25.2），P=.007。
在非综合征性 uWT 的高度选择患者人群中，与 RN 相比，NSS 可提供出色的肾功能保留。这些数据需要通过更大规模的前瞻性研究进行验证。
