Grundy P, Breslow N, Green D M, Sharples K, Evans A, D'Angio G J
Ludwig Institute for Cancer Research, Montreal Branch, Canada.
J Clin Oncol. 1989 May;7(5):638-47. doi: 10.1200/JCO.1989.7.5.638.
The characteristics of 367 stage I-IV National Wilms' Tumor Study (NWTS) children who relapsed after initial treatment for unilateral disease in the second and third NWTS trials (NWTS-2 and -3) were analyzed to identify features predictive of survival. Although modifications in initial therapy resulted in a lower rate of first relapse in these two studies compared with NWTS-1, all previously identified prognostic factors after relapse remained statistically significant predictors of survival. Tumor histology, length of initial remission, initial therapy with two v three drugs, and site of relapse each were independently predictive of postrelapse survival. The 3-year postrelapse survival for all 367 patients was 30% +/- 3%; however, subgroups classified by these prognostic factors were identified that had 3-year postrelapse survival rates of greater than 40%. These subgroups included patients who had tumors of favorable histology (FH) that recurred (1) only in the lungs, (2) in the abdomen when radiotherapy (RT) was not initially given, or (3) that were originally stage I, (4) that were originally treated with only two drugs, or (5) that recurred 12 months or more after diagnosis. These results were achieved with the use of standard treatments, ie, surgery, RT, and chemotherapy using dactinomycin (AMD), vincristine (VCR), and Adriamycin [( ADR] doxorubicin; Adria Laboratories, Columbus, OH). It is suggested that patients in these groups might be managed with aggressive use of conventional therapies until newer chemotherapeutic agents and drug combinations are shown to be more effective. Patients with adverse prognostic features at relapse have a poor survival expectancy with standard measures. Salvage attempts for these patients are better based on experimental approaches.
对367例在国家肾母细胞瘤研究（NWTS）第二和第三次试验（NWTS - 2和 - 3）中接受单侧疾病初始治疗后复发的I - IV期儿童患者的特征进行了分析，以确定预测生存的特征。尽管与NWTS - 1相比，这两项研究中初始治疗的调整导致首次复发率降低，但所有先前确定的复发后预后因素在统计学上仍然是生存的显著预测因素。肿瘤组织学、初始缓解期长度、使用两种或三种药物的初始治疗以及复发部位各自独立预测复发后生存。所有367例患者的复发后3年生存率为30%±3%；然而，通过这些预后因素分类的亚组被确定其复发后3年生存率大于40%。这些亚组包括具有良好组织学（FH）肿瘤且复发的患者：（1）仅在肺部复发；（2）在未初始给予放疗（RT）时在腹部复发；（3）最初为I期；（4）最初仅用两种药物治疗；或（5）在诊断后12个月或更长时间复发。这些结果是通过使用标准治疗方法取得的，即手术、放疗以及使用放线菌素D（AMD）、长春新碱（VCR）和阿霉素[（ADR）多柔比星；阿德里亚实验室，俄亥俄州哥伦布市]进行化疗。建议对这些组中的患者积极使用传统疗法进行管理，直到更新的化疗药物和药物组合被证明更有效。复发时具有不良预后特征的患者采用标准措施的生存预期较差。对这些患者的挽救尝试基于实验方法可能会更好。
