Davidoff A M, Soutter A D, Shochat S J
Department of Surgery, Children's Hospital of Philadelphia, Pennsylvania, USA.
Ann Surg Oncol. 1998 Apr-May;5(3):213-5. doi: 10.1007/BF02303774.
Although significant progress has been made in the management of children with Wilms tumor, two major controversies still exist: the extent of radiographic evaluation necessary before surgery and the role of preoperative chemotherapy. This study sought to determine whether patients with Wilms tumor who presented with abdominal pain defined a special subset of patients who might require a more extensive preoperative work-up and neoadjuvant chemotherapy.
From 1970 to 1995, 250 children were treated for Wilms tumor at a single pediatric institution. A retrospective chart review determined presenting signs and symptoms for each patient.
Thirty-four (14%) patients (mean age 5.5 years) sought medical attention with a chief complaint of abdominal pain. The stage distribution for these patients tended to be higher and was significantly different (P <.001, chi(2)-analysis) from those presenting without pain. Four (14%) of 29 patients with tumor available for analysis were found to have anaplastic histology.
These data suggest that patients with Wilms tumor who present with abdominal pain represent a special subgroup that tends to be older and has an increased incidence of tumor rupture, anaplasia, and higher stage. These patients may benefit from a more extensive preoperative evaluation and consideration of neoadjuvant chemotherapy.
尽管在肾母细胞瘤患儿的治疗方面已取得显著进展，但仍存在两个主要争议：手术前所需的影像学评估范围以及术前化疗的作用。本研究旨在确定以腹痛就诊的肾母细胞瘤患者是否构成一个特殊的患者亚组，这类患者可能需要更广泛的术前检查和新辅助化疗。
1970年至1995年期间，一家儿科机构对250例儿童肾母细胞瘤患者进行了治疗。通过回顾病历确定每位患者的就诊体征和症状。
34例（14%）患者（平均年龄5.5岁）以腹痛为主诉就医。这些患者的分期分布往往较高，与无疼痛症状就诊的患者相比有显著差异（P<.001，卡方分析）。在29例可供分析的肿瘤患者中，有4例（14%）被发现具有间变组织学特征。
这些数据表明，以腹痛就诊的肾母细胞瘤患者代表一个特殊的亚组，该亚组患者往往年龄较大，肿瘤破裂、间变和分期较高的发生率增加。这些患者可能受益于更广泛的术前评估以及对新辅助化疗的考虑。
