Department of Pediatric Oncology, National Cancer Institute, Cairo University, Fom El-khalig Square, Kasr El-Aini St, Cairo, 11796, Egypt.
Department of Pathology, National Cancer Institute, Cairo University, Fom El-khalig Square, Kasr El-Aini St., Cairo, 11796, Egypt.
J Egypt Natl Canc Inst. 2020 May 1;32(1):21. doi: 10.1186/s43046-020-00032-6.
Wilms' tumor (WT) affects one in 10,000 children and accounts for 5% of all childhood cancers. Although the overall relapse rate for children with WT has decreased to less than 15 %, the overall survival for patients with recurrent disease remains poor at approximately 50 %. The aim of the study to evaluate the outcome of relapsed Wilms' tumor pediatric patients treated at the National Cancer Institute (NCI), Egypt, between January 2008 and December 2015.
One hundred thirty (130) patients diagnosed with WT during the study period, thirty (23%) patients had relapsed. The median follow up period was 22.3 months (range 3.6-140 months). The Overall Survival (OS) was 30.9% while the event-free survival (EFS) was 29.8% at a 5-year follow up period. Median time from diagnosis to relapse was 14.4 months. A second complete remission was attained in 18/30 patients (60%). The outcome of the 30 patients; 11 are alive and 19 had died. Three factors in our univariate analysis were prognostically significant for survival after relapse. The first was radiotherapy given after relapse (p = 0.012). The 5-year EFS and OS for the group that received radiotherapy were 41.9% versus 16.7% and 11.1% respectively for those that did not. The second was the state of lymph nodes among patients with local stage III (p = 0.004). Lastly, when risk stratification has been applied retrospectively on our study group, it proved to be statistically significant (p = 0.029).
Among relapsed pediatric WT, radiotherapy improved survival at the time of relapse and local stage III with positive lymph nodes had the worst survival among other stage III patients.
肾母细胞瘤（WT）影响每万名儿童中的 1 人，占所有儿童癌症的 5%。尽管儿童 WT 的总体复发率已降至 15%以下，但复发性疾病患者的总体生存率仍较差，约为 50%。本研究旨在评估 2008 年 1 月至 2015 年 12 月在埃及国家癌症研究所（NCI）治疗的复发肾母细胞瘤儿科患者的结果。
在研究期间诊断为 WT 的 130 例患者中，有 30 例（23%）复发。中位随访期为 22.3 个月（范围 3.6-140 个月）。5 年随访时，总体生存率（OS）为 30.9%，无事件生存率（EFS）为 29.8%。从诊断到复发的中位时间为 14.4 个月。18/30 例（60%）患者获得第二次完全缓解。30 例患者的结果为：11 例存活，19 例死亡。我们的单因素分析中有 3 个因素对复发后的生存具有预后意义。第一个是复发后给予的放疗（p=0.012）。接受放疗的患者 5 年 EFS 和 OS 分别为 41.9%和 11.1%，未接受放疗的患者分别为 16.7%。第二个是局部 III 期患者的淋巴结状态（p=0.004）。最后，当我们对研究组进行回顾性风险分层时，发现它具有统计学意义（p=0.029）。
在复发的儿科 WT 中，放疗改善了复发时和局部 III 期（伴有阳性淋巴结）的生存，而其他 III 期患者中，淋巴结状态阳性的患者生存最差。
