Weeks D A, Beckwith J B, Luckey D W
Cancer. 1987 Sep 15;60(6):1204-12. doi: 10.1002/1097-0142(19870915)60:6<1204::aid-cncr2820600608>3.0.co;2-w.
All 24 cases of confirmed and evaluable Stage I favorable histology (FH) Wilms' tumor (WT) relapsing to date on the Third National Wilms' Tumor Study (NWTS-3) were compared with 48 matched control subjects who had not relapsed for at least 2 years after diagnosis. Fifteen of the clinical and pathological variables studied, including patient age and tumor size, had no significant relationship to the outcome of this study. Four histologic features, all related to the degree of tumor extension within the "tumor-kidney unit" proved to be significantly associated with relapse. These were (1) invasion of the tumor capsule, (2) presence of an "inflammatory pseudocapsule," (3) renal sinus invasion, and (4) tumor in intrarenal vessels. One or more of these features was present in 100% of relapsed cases (excluding one for which two variables were unevaluable), but occurred in only 46% of controls (P less than 0.0002). Therefore, no relapses occurred in the NWTS-3 when all four variables were negative. This result was confirmed by a review of all Stage I cases in the NWTS-1 who had relapsed and who were treated by single-agent chemotherapy. Again, no relapses occurred when all four factors were negative. These results demonstrate the feasibility of "microsubstaging" and could serve as a basis for future refinements of therapy for Stage I favorable histology Wilms' tumor.
对第三次全国肾母细胞瘤研究（NWTS - 3）中迄今确诊且可评估的24例I期预后良好组织学类型（FH）肾母细胞瘤（WT）复发患者，与48例匹配的对照受试者进行了比较，这些对照受试者在诊断后至少2年未复发。所研究的15项临床和病理变量，包括患者年龄和肿瘤大小，与本研究结果均无显著关系。四项组织学特征，均与肿瘤在“肿瘤 - 肾脏单位”内的扩展程度相关，被证明与复发显著相关。这些特征为：（1）肿瘤包膜侵犯；（2）“炎性假包膜”的存在；（3）肾窦侵犯；（4）肾内血管内肿瘤。这些特征中的一项或多项存在于100%的复发病例中（不包括两个变量不可评估的1例），但仅在46%的对照受试者中出现（P小于0.0002）。因此，当所有四个变量均为阴性时，NWTS - 3中未发生复发。对NWTS - 1中所有复发且接受单药化疗的I期病例进行回顾，证实了这一结果。同样，当所有四个因素均为阴性时，未发生复发。这些结果证明了“微分期”的可行性，并可为未来I期预后良好组织学类型肾母细胞瘤治疗的改进提供依据。
