[肾母细胞瘤幸存者的长期肾功能]

[Long-term renal function in Wilms tumor survivors].

作者信息

Sánchez Sánchez A, Girón Vallejo O, Ruiz Pruneda R, Fernández Ibieta M, Villamil V, Giménez Aleixandre M C, Montoya-Rangel C A, Fuster J L, Pascual Gázquez J F, Ortega García J A, Cárceles Álvarez A, Vicente Calderón C, Zambudio Carmona G, Ruiz Jiménez J I, Hernández Bermejo J P

机构信息

Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia.

Servicio de Oncología Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia.

出版信息

Cir Pediatr. 2019 Apr 22;32(2):86-92.

PMID:31056869

Abstract

OBJETIVE

To evaluate long-term renal function and morbimortality in non-syndromic Wilms tumor (WT) survivors.

METHODS

Retrospective study about WT patients treated in 1993-2017, according to SIOP protocols. Mortality, glomerular filtration rate (GFR), prevalence of hypertension and requirement of dialysis and renal transplant were evaluated. Chronic kidney disease (CKD) was defined as GFR <90 ml/min/1.73 m2.

RESULTS

Thirty-nine children were treated in the 25 analyzed years. Median time of follow-up was 6 years (0.5-21 years). 48% (19 patients) debuted with stage I or II. Four cases had high-grade histo-logy. Mortality rate was 10%. GFR data were found in 37 patients. Chronic kidney disease (grade I-II) turned up in 6 patients (16%). No patient required renal replacement therapy or renal transplant. 16% of patients developed CKD in both unilateral and bilateral WT, (p>0.05); OR 1.04 (IC 95% 0.09-10.9). Identical results were obtained comparing patients treated with or without radiotherapy (16%). Children with stage I-III had CKD in 11% vs. 40% of patients with stage IV (p=0.12); OR 5.3 (IC 95% 0.61-45). None of them presented hypertension in addition.

CONCLUSIONS

In the current study the prevalence of CKD was low but not negligible, although no patients required renal replacement therapy or renal transplant. Bilateral renal involvement and radiotherapy were not associated with CKD development. Metastatic disease determines a higher risk of CKD.

摘要

目的

评估非综合征性肾母细胞瘤（WT）幸存者的长期肾功能及疾病死亡率。

方法

根据国际小儿肿瘤学会（SIOP）方案，对1993年至2017年接受治疗的WT患者进行回顾性研究。评估死亡率、肾小球滤过率（GFR）、高血压患病率以及透析和肾移植需求。慢性肾脏病（CKD）定义为GFR<90 ml/min/1.73 m²。

结果

在分析的25年中，39名儿童接受了治疗。中位随访时间为6年（0.5 - 21年）。48%（19例患者）初诊为I期或II期。4例为高级别组织学类型。死亡率为10%。37例患者有GFR数据。6例患者（16%）出现慢性肾脏病（I - II级）。无患者需要肾脏替代治疗或肾移植。16%的单侧和双侧WT患者发生CKD，（p>0.05）；比值比（OR）为1.04（95%置信区间[IC]为0.09 - 10.9）。比较接受或未接受放疗的患者，结果相同（16%）。I - III期儿童CKD发生率为11%，而IV期患者为40%（p = 0.12）；OR为5.3（95%IC为0.61 - 45）。此外，他们均未出现高血压。