Yao Atteby Jean-Jacques, Moreira Claude, Traoré Fousseyni, Kaboret Sonia, Pondy Angele, Rakotomahefa Narison Mbolanirina Lala, Guedenon Koffi M, Mallon Brenda, Patte Catherine
Hôpital de Treichville, Abidjan, Ivory Coast.
Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Senegal.
J Glob Oncol. 2019 Sep;5:1-8. doi: 10.1200/JGO.18.00204.
Multidisciplinary management of Wilms tumor has been defined through multicenter prospective studies and an average expected patient cure rate of 90%. In sub-Saharan Africa, such studies are uncommon. After the encouraging results of the first Groupe Franco-Africain d'Oncologie Pédiatrique (GFAOP) study, we report the results of the GFAOP-NEPHRO-02 study using an adaptation of the International Society of Paediatric Oncology 2001 protocol.
From April 1, 2005, to March 31, 2011, seven African units participated in a nonrandomized prospective study. All patients who were referred with a clinical and radiologic diagnosis of renal tumor were screened. Those older than age 6 months and younger than 18 years with a unilateral tumor previously untreated were pre-included and received preoperative chemotherapy. Patients with unfavorable histology or with a tumor other than Wilms, or with a nonresponding stage IV tumor were excluded secondarily.
Three hundred thirteen patients were initially screened. Two hundred fifty-seven patients were pre-included and 169 with histologic confirmation of intermediate-risk nephroblastoma were registered in the study and administered postoperative treatment. Thirty-one percent of patients were classified as stage I, 38% stage II, 24% stage III, and 7% stage IV. Radiotherapy was not available for any stage III patients. Three-year overall survival rate was 72% for all study patients and 73% for those with localized disease.
It was possible to conduct sub-Saharan African multicenter therapeutic studies within the framework of GFAOP. Survival results were satisfactory. Improvements in procedure, data collection, and outcome are expected in a new study. Radiotherapy is needed to reduce the relapse rate in patients with stage III disease.
通过多中心前瞻性研究已明确了肾母细胞瘤的多学科管理方式，患者的平均预期治愈率为90%。在撒哈拉以南非洲地区，此类研究并不常见。在首个法非儿科肿瘤学组（GFAOP）研究取得令人鼓舞的结果之后，我们报告了采用国际儿科肿瘤学会2001年方案改编版的GFAOP-NEPHRO-02研究结果。
2005年4月1日至2011年3月31日，七个非洲单位参与了一项非随机前瞻性研究。对所有因临床和影像学诊断为肾肿瘤而转诊的患者进行筛查。年龄大于6个月且小于18岁、单侧肿瘤且此前未接受过治疗的患者被预先纳入并接受术前化疗。组织学类型不良或肿瘤不是肾母细胞瘤、或IV期肿瘤无反应的患者被再次排除。
最初筛查了313例患者。257例患者被预先纳入，169例经组织学确诊为中危肾母细胞瘤的患者被纳入研究并接受术后治疗。31%的患者被分类为I期，38%为II期，24%为III期，7%为IV期。所有III期患者均无法获得放疗。所有研究患者的三年总生存率为72%，局限性疾病患者为73%。
在GFAOP框架内开展撒哈拉以南非洲地区的多中心治疗研究是可行的。生存结果令人满意。预计在一项新研究中程序、数据收集和结果会有所改善。需要放疗以降低III期疾病患者的复发率。
