Wilimas J A, Douglass E C, Magill H L, Fitch S, Hustu H O
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105.
J Clin Oncol. 1988 Jul;6(7):1144-6. doi: 10.1200/JCO.1988.6.7.1144.
Pulmonary lesions were found by computed tomography (CT) despite normal chest roentgenograms (CXR) at diagnosis in 11 of 124 patients with Wilms' tumor. All patients were entered on a treatment protocol at St Jude Children's Research Hospital from 1978 to 1986. The 11 patients all had favorable histology Wilms' tumor. Staging and therapy were based on interpretation of the CXR and abdominal findings. Excluding CT findings, one patient had stage I disease, two stage II, seven stage III, and one stage IV on the basis of multiple liver metastases. Four patients have relapsed: one with stage II and three with stage III. All relapses have been pulmonary. Overall, 4/11 (36%) relapsed. This relapse rate is considerably greater than the 20% overall relapse rate of patients treated according to this protocol though not statistically significant. These relapses suggest that such patients may be at increased risk for pulmonary recurrence. The results also indicate that small lesions initially noted only on CT scans of the chest in children with Wilms' tumor frequently represent metastatic tumor. Further studies of larger numbers of patients will be necessary to confirm these findings.
在124例威尔姆斯瘤患者中，有11例在诊断时胸部X线片（CXR）正常，但计算机断层扫描（CT）发现了肺部病变。所有患者于1978年至1986年进入圣裘德儿童研究医院的治疗方案。这11例患者均为组织学类型良好的威尔姆斯瘤。分期和治疗基于胸部X线片和腹部检查结果。排除CT检查结果，1例患者为I期疾病，2例为II期，7例为III期，1例因多发肝转移为IV期。4例患者复发：1例为II期，3例为III期。所有复发均为肺部复发。总体而言，11例中有4例（36%）复发。尽管无统计学意义，但该复发率明显高于按照此方案治疗患者的总体20%复发率。这些复发提示此类患者可能有更高的肺部复发风险。结果还表明，威尔姆斯瘤患儿最初仅在胸部CT扫描中发现的小病变常代表转移性肿瘤。需要对更多患者进行进一步研究以证实这些发现。
