晚期肾肿瘤23例远期疗效分析  

Late outcome observation to 23 children with advanced renal tumors

作　　者：张婧[1] 潘慈[1] 叶启东 周敏[1] 薛惠良[1] 陈静[1] 江华[1] 罗长缨[1] 沈树红[1] 王坚敏 汤燕静 汤静燕[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,200127

出　　处：《中华小儿外科杂志》2012年第9期655-659,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的研究初诊无手术条件的Ⅲ、Ⅳ、Ⅴ期肾肿瘤术前化疗的有效性及整体治疗方案的远期疗效。分析病理分型、临床分期及早期治疗反应与预后的关系。方法制定晚期肾肿瘤诊断治疗方案，根据方案进行诊断、分期、分组，并给予相应治疗。所有患儿均在术前予两个疗程异环磷酰胺、长春新碱联合足叶乙甙化疗，术后辅以放疗并根据分期及病理继续化疗。生存分析采用Kaplan-Meier法。结果1999年3月至2009年3月间共收治23例Ⅲ、Ⅳ、Ⅴ期无手术条件的肾肿瘤，包括Ⅲ期11例，Ⅳ期9例，Ⅴ期3例。病理为预后良好型（FH型）15例，预后不良型（UFH）5例，透明细胞肉瘤（cs）2例，横纹肌样瘤（Rt）1例。23例患儿均获得随访，18例（78．3％）在2个疗程化疗后转移灶消失、原发肿瘤完全切除，5例（21．7％）在3个疗程后手术。随访至2011年4月30日，17例（73．9％）仍存活，6例（26．1％）已死亡。2年和估计5年总生存率分别为90．9X和66．2％。FH型患儿的2年和估计5年总生存率均高于UFH及Cs、Rt型患儿（P=0．028）。Ⅲ期优于Ⅳ期、Ⅴ期（P：0．046）。结论异环磷酰胺、长春新碱联合足叶乙甙术前化疗对晚期肾肿瘤有效，病理亚型、临床分期及早期治疗反应对本组患儿的预后有影响。Objective To investigate the therapertic efficacy of preoperative chemotherapy and long term of outcomes for advanced renal tumors, and explore the correlation among the prognostic factors including pathological sub-types of tumor and clinical stages and early efficacy, as well as prognosis. Methods Diagnostic protocols, staging and treatments were designed in advance for childhood with renal tumors. The protocol worked as guideline for surgical procedure, chemotherapy and radiotherapy. All the patients were administrated with 2 courses of ifosfamide/vincristine combined with etoposide before procedure in patient whose tumor could not originally be removed completely, and radi- ation therapy was employed after surgery. Continues chemotherapy was conducted for 24 - 26 weeks in post-operation. Kaplan-Meier method was used to to Mar. 2009, totally 23 patients with advanced renal analyze survival rate. Results From Mar. 1999 tumors underwent comprehensive therapy in out center, including stage Ⅲ in 11 patients, stage Ⅳ in 9 patients and stage Ⅴin 3 patients. Among all unfavorahle prognosis （UFH） was found in 5 patients with Wilms＇ tumor, favorable prognosis （FH） in 15 cases of Wilms＇ tumor, clear cell sarcoma in 2 cases and rhabdoid tumor in 1 case. All patients underwent follow up study. Tumors in 18 patients were removed completely after 2 courses of chemotherapy（78.3%）and 5 cases（21.7%） underwent surgery after 3 courses of chemotherapy. 17 cases （73.9% are still alive in all patients,and 6（26. 1 %）died due to progressive disease or relapse. 2-and 5- year overall survival rates were 90. 9% and 66. 2% respectively. The survival rates in cases with FH type were higher than those with UFH type, Cs and Rt type （P = 0. （!28）. The therapeutic efficacy for patients with Ⅲ stage tumor was superior to those with Ⅳand Ⅴ stage （P ： 0. 046）. Conclusions The administration of ifosfamide,vincristine and etoposide chemotherapy in pre-surgery is an effective approach to treat patie

关 键 词：肾肿瘤 综合疗法 预后 

分 类 号：R737.11[医药卫生—肿瘤]