Lim Irene Isabel P, Goldman Debra A, Farber Benjamin A, Murphy Jennifer M, Abramson Sara J, Basu Ellen, Roberts Stephen, LaQuaglia Michael P, Price Anita P
Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
J Pediatr Surg. 2016 Jun;51(6):975-80. doi: 10.1016/j.jpedsurg.2016.02.069. Epub 2016 Mar 2.
Although nephrectomy rates are higher in children with neuroblastoma who have image-defined risk factors and/or high-risk disease who undergo resection prior to chemotherapy, no published data outline the key radiographic and clinical characteristics associated with nephrectomy.
With IRB approval, imaging studies of children undergoing primary resection of intraabdominal neuroblastoma between 2000 and 2014 were retrospectively reviewed. Fisher's exact and Wilcoxon rank-sum tests were used to compare categorical and continuous variables, respectively, with p-values adjusted for multiple testing using the false discovery rate approach.
Twenty-seven of 380 consecutive patients with CT imaging obtained prior to primary neuroblastoma resection underwent partial or total nephrectomy. On preoperative imaging, renal vessel narrowing and encasement and tumor invasion of the renal hilum, pelvis, and/or parenchyma were present significantly more frequently among patients undergoing nephrectomy. Delayed renal excretion of contrast, hydronephrosis, and tumors with MYCN amplification were also more prevalent in the nephrectomy group.
Encasement and narrowing of renal vessels, delayed excretion, and tumor invasion into the kidney, particularly pelvis and capsule invasion, are significantly associated with partial or total nephrectomy at initial neuroblastoma resection. These observations provide valuable information for surgical planning as well as presurgical discussions with families prior to neuroblastoma resection.
尽管在化疗前接受手术切除的患有影像定义风险因素和/或高危疾病的神经母细胞瘤患儿中，肾切除率较高，但尚无已发表的数据概述与肾切除相关的关键影像学和临床特征。
经机构审查委员会批准，对2000年至2014年间接受腹腔内神经母细胞瘤初次切除的患儿的影像学研究进行回顾性分析。分别采用Fisher精确检验和Wilcoxon秩和检验比较分类变量和连续变量，并使用错误发现率方法对p值进行多重检验校正。
在380例原发性神经母细胞瘤切除术前接受CT成像的连续患者中，27例接受了部分或全肾切除术。术前影像学检查显示，肾切除术患者中肾血管狭窄、包绕以及肿瘤侵犯肾门、肾盂和/或肾实质的情况明显更为常见。肾造影剂排泄延迟、肾积水以及MYCN扩增的肿瘤在肾切除组中也更为普遍。
肾血管包绕和狭窄、排泄延迟以及肿瘤侵犯肾脏，尤其是肾盂和包膜侵犯，与初次神经母细胞瘤切除时的部分或全肾切除术显著相关。这些观察结果为手术规划以及神经母细胞瘤切除术前与家属的术前讨论提供了有价值的信息。
