Koshinaga Tsugumichi, Takimoto Tetsuya, Okita Hajime, Tanaka Yukichi, Inoue Eisuke, Oue Takaharu, Nozaki Miwako, Tsuchiya Kunihiko, Haruta Masayuki, Kaneko Yasuhiko, Fukuzawa Masahiro
Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
Division of Registration and Research for Childhood Cancer, Research Institute, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Int. 2019 Apr;61(4):351-357. doi: 10.1111/ped.13811. Epub 2019 Apr 16.
Persistence of blastemal components after chemotherapy is a marker of poor outcome in Wilms tumor (WT). Recent reports from local Japanese areas have described pre-chemotherapy blastemal predominant type WT to also be a risk factor for relapse. The significance, however, of blastemal predominant WT remains to be evaluated in a larger study. This study retrospectively evaluated the prognostic significance of pre-chemotherapy blastemal predominant type WT in the Japan Wilms tumor Study (JWiTS) trials.
The JWiTS trial (1996-2013) was a prospective, single-arm study. The outcomes of blastemal predominant type WT were retrospectively evaluated compared with non-blastemal type WT excluding anaplasia between 1996 and 2013. Relapse-free survival (RFS) and overall survival (OS) were estimated.
Of 319 primary renal tumors diagnosed by the central pathology review system, advanced stage of pre-chemotherapy blastemal predominant type WT (n = 53; 16.1%) occurred more frequently in older children than non-blastemal type WT (n = 225), and was especially frequent in female patients registered in the JWiTS trials. No significant difference in 10 years RFS and OS (78.8% vs 84.5; P = 0.201) or in 10 years RFS and OS (89.3% vs 93.5; P = 0.45) was seen between pre-chemotherapy blastemal predominant type and non-blastemal type WT.
Relapse-free survival and OS are not significantly different between pre-chemotherapy blastemal predominant type and non-blastemal type WT.
化疗后胚芽成分的持续存在是肾母细胞瘤（WT）预后不良的一个标志。日本当地地区最近的报告描述了化疗前胚芽为主型WT也是复发的一个危险因素。然而，胚芽为主型WT的意义仍有待在更大规模的研究中进行评估。本研究回顾性评估了化疗前胚芽为主型WT在日本肾母细胞瘤研究（JWiTS）试验中的预后意义。
JWiTS试验（1996 - 2013年）是一项前瞻性单臂研究。回顾性评估了1996年至2013年间胚芽为主型WT与非胚芽型WT（不包括间变）的预后。估计了无复发生存期（RFS）和总生存期（OS）。
在通过中央病理审查系统诊断的319例原发性肾肿瘤中，化疗前胚芽为主型WT的晚期病例（n = 53；16.1%）在大龄儿童中比非胚芽型WT（n = 225）更常见，在参加JWiTS试验的女性患者中尤其常见。化疗前胚芽为主型WT与非胚芽型WT之间在10年RFS和OS（78.8% 对84.5；P = 0.201）或10年RFS和OS（89.3% 对93.5；P = 0.45）方面均未观察到显著差异。
化疗前胚芽为主型WT与非胚芽型WT之间的无复发生存期和OS无显著差异。
