多学科协作模式对肾母细胞瘤治疗的影响  

Multi-disciplinary approach in managing Wilms' tumor

作　　者：叶惟靖[1] 汤静燕[2] 赵海腾[2] 孙杰[2] 刘毅东[1] 王元天[1] 

机构地区：[1]上海第二医科大学附属仁济医院泌尿科(东部),200127 [2]上海第二医科大学附属新华医院上海儿童医学中心血液肿瘤科/外科

出　　处：《中华小儿外科杂志》2004年第3期201-204,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的　探讨肾母细胞瘤的治疗模式及提高肾母细胞瘤的治疗效果。方法　对 1998～2 0 0 1年明确诊断的 2 0例肾母细胞瘤采用多学科协作模式进行治疗 ,即以NWTS 5治疗方案为蓝本由泌尿科、血液肿瘤科、放疗科、放射科、病理科等学科共同制定统一的治疗方案 ,通过分工协作按统一模式对Wilms’瘤根据分期、病理类型及其他危险因素进行分组并按不同分组实施相应综合治疗。治疗结果与 1995年 8月～ 1998年 5月传统治疗模式下的由泌尿科单学科负责治疗 (包括手术、化疗、放疗、肾动脉栓塞、LAK细胞治疗等 )的 16例Wilms’瘤比较 ,以了解不同治疗模式对Wilms’瘤疗效的影响。结果　本组Ⅰ期 5例 ;Ⅱ期 5例 ;Ⅲ期 6例 ;Ⅳ期 3例 ;Ⅴ期 1例。病例分型FH型 14例 ;UFH型 3例 ;透明细胞肉瘤 2例和恶性肾横纹肌样肉瘤 1例。初治停药复发病例 1例 (复发率 5 % ) ,再次治疗完全缓解 ;初治失败并死亡 2例 ,病死率 10 %。目前无瘤生存 18例 (90 .0 % ) ,均已停药。对照组 :复发并死亡 6例 ,分别于术后 2个月至 8年死亡 ,复发率及病死率为 37.5 0 %。目前无瘤生存10例 (6 2 .5 0 % )。结果经统计学处理 ,二组疗效差异有显著性意义 (P <0 .0 5 )。结论　多学科协作模式下Wilms’瘤的综合治疗较果比单一泌尿科负责治疗有效。Objective Purpose To evaluate the multi-disciplinary approach in managing Wilms' Tumor. Methods Diagnosis and treatment was carried out by a multi-disciplinary team including pediatric urologists,oncologists,pathologists,radiologists and diagnostic radiologists. The NWTS-5's anti-neoplastic protocol was adopted. A total of 20 consecutively diagnosed patients (aged 7 months to 12 years,mean=2 years and 3 months) were recruited between October 1998 to October 2001. The outcomes were compared with those of 16 Wilms' tumor cases treated by the same pediatric urologists from August 1995 to May 1998. Results Pathologies included 14 FH,3 UFH,2 clear cell sarcoma of kidney (CCSK) and one malignant rhabdoid tumor of kidney (MRT). Five patients were of stage Ⅰ,5 of stage Ⅱ,6 of stage Ⅲ,3 of stage Ⅳ and 1 of stage Ⅴ. Eighteen are currently disease free ( 90.00% ),and 2 with disease. No therapy-related death occurred. One patient relapsed after 24 months of CCR and reached CR again after second intensive chemotherapy. Survival rate was 90%. In the control group,six (6/16) patients relapsed and died. The relapse and death rates were 37.5% . Survival rate was (EFS) 62.50% . The difference of the outcomes between the two groups was significant( P < 0.05 ).Conclusions Multi-disciplinary approach is safer and more effective than single disciplinary approach in the management of Wilms' tumor.

关 键 词：多学科协作模式 肾母细胞瘤 肿瘤 NWTS-5 肾胚胎瘤 

分 类 号：R737.11[医药卫生—肿瘤]