National Institutes of Health, Bethesda, Maryland.
Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia.
Int J Radiat Oncol Biol Phys. 2015 Jun 1;92(2):332-8. doi: 10.1016/j.ijrobp.2015.01.012. Epub 2015 Mar 5.
Chest computed tomography (CT) is currently accepted as the main modality for initial disease staging and response assessment in Wilms tumor (WT). However, there is great variability in the number and size of lung metastases at the time of diagnosis and after induction chemotherapy. There is a lack of clinical evidence as to how this variability in tumor burden affects choice of therapy and disease outcome. This study sought to evaluate a previously proposed lung metastases risk stratification system based on CT findings and clinical outcomes in stage IV WT patients.
Thirty-five pediatric patients with a diagnosis of stage IV WT with evaluable pre- and postdiagnosis CT scans between 1997 and 2012 were included in the analysis. Patients were divided into low-, intermediate-, and high-risk categories based on the size and number of pulmonary metastases before and after 6 weeks of chemotherapy. Association of the lung risk groups with lung recurrence-free survival and overall survival at each time point was analyzed with relevant covariates.
Risk group distribution both at diagnosis and after induction chemotherapy was not influenced by tumor histology. Initial risk grouping suggested an association with disease-free survival at 5 years (P=.074); however, the most significant correlation was with postinduction chemotherapy disease status (P=.027). In patients with an intermediate or high burden of disease after 6 weeks of chemotherapy, despite receiving whole-lung and boost irradiation, survival outcomes were poorer.
Pulmonary tumor burden in stage IV WT on chest CT can predict disease outcome. Patients with intermediate- or low-risk disease, especially after induction therapy, have a higher risk for recurrence. After prospective validation, this method may become a valuable tool in adaptation of therapy to improve outcome.
胸部计算机断层扫描（CT）目前被认为是用于初始疾病分期和反应评估的主要方式在威尔姆斯瘤（WT）中。然而，在诊断时和诱导化疗后，肺转移的数量和大小存在很大的差异。缺乏临床证据表明肿瘤负担的这种变化如何影响治疗选择和疾病结局。本研究旨在评估一种基于 CT 发现和 IV 期 WT 患者临床结局的先前提出的肺转移风险分层系统。
分析了 1997 年至 2012 年间诊断为 IV 期 WT 且具有可评估的前后 CT 扫描的 35 例儿科患者。根据化疗前 6 周肺转移的大小和数量，将患者分为低、中、高危组。分析肺风险组与每个时间点的肺无复发生存率和总生存率的相关性，并进行相关协变量分析。
诊断时和诱导化疗后的风险组分布不受肿瘤组织学的影响。初始风险分组与 5 年无病生存率相关（P=.074）；然而，与诱导化疗后疾病状态的相关性最显著（P=.027）。在接受全肺和升压照射后，尽管有中间或高疾病负担的患者，其生存结果较差。
WT 患者的胸部 CT 显示的肺部肿瘤负担可以预测疾病结局。中危或低危疾病患者，特别是在诱导治疗后，复发风险较高。经过前瞻性验证，这种方法可能成为一种有价值的工具，可以根据治疗情况进行调整，以改善结局。
