"肾母细胞瘤的治疗建议CCCG-WT-2016方案"2019修订版病理分类应用效果分析  

Application of the pathological classification of"CCCG-WT-2016"(2019 revision)for treatment of Wilms tumors

作　　者：何巧 张道恩 陈湾湾[3] 马靖 沈萍 陈洁枫 金晓婷 张忠德[1] 殷敏智[1] He Qiao;Chang Kenneth TouEn;Chen Wanwan;Ma Jing;Shen Ping;Chen Jiefeng;Jin Xiaoting;Zhang Zhongde;Yin Minzhi(Department of Pathology,Shanghai Children′s Medical Center,Shanghai Jiaotong University,School of Medicine,Shanghai 200127,China;Department of Pathology,Singapore KK Women′s and Children′s Hospital,Singapore 229899,Singapore;Department of Pathology,the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心病理科,200127 [2]Department of Pathology,Singapore KK Women′s and Children′s Hospital,Singapore 229899,Singapore [3]温州医科大学附属第二医院,育英儿童医院病理科,325000

出　　处：《中华病理学杂志》2020年第4期324-328,共5页Chinese Journal of Pathology

基　　金：上海交通大学转化医学交叉研究基金(ZH2018ZDA25)。

摘　　要：目的:探讨"肾母细胞瘤的治疗建议CCCG-WT-2016方案"2019修订版病理分类在临床实际工作中的应用价值。方法:收集上海儿童医学中心病理科2015年1月至2018年12月期间91例肾母细胞瘤手术标本、临床资料,经中国及新加坡两地两位高级病理医师审阅,根据修订方案病理内容分别给予病理诊断及危险度分层,并对诊断结果进行分析。结果:按照修订版病理分类标准,91例病例中(1)肾活检21例,组织学分型均为组织分化良好型(FH)型;(2)直接手术肾切除41例,组织学分型均为FH型;(3)化疗后肾及肿瘤切除18例中,12例化疗后肾切除标本中组织学危险度分层低危0例、中危10例、高危2例;6例化疗后肿瘤切除标本中危险度分层低危0例、中危5例、高危1例;(4)其他,包括转移/复发及复发化疗后转移灶共11例,均为肾母细胞瘤。除化疗后肾及肿瘤切除标本中出现2例初期诊断不一致,经过讨论后达成一致,最终所有病例诊断一致率为100%(91/91)。结论:2019修订方案中病理分类标准清晰、易操作,对指导临床治疗能提供准确的依据。Objective To describe our experiences in application of the 2019 revision of"CCCG-WT-2016"for the diagnosis of Wilms tumors.Methods Ninety-one cases of Wilms tumor diagnosed at Shanghai Children′s Medical Center from January 2015 to December 2018 were collected.All cases were reviewed by two senior pathologists,including one from China and the other from Singapore,according to the 2019 revision of"CCCG-WT-2016."Results The specimens were obtained by core biopsy(n=21),primary nephrectomy(n=41),post-chemotherapy nephrectomy/resection(n=18),or biopsy/resection of metastatic/relapse/post-chemotherapy metastatic lesion(s)(n=11).The specimens of core biopsy and primary nephrectomy(n=62)all had favorable histology.Twelve post-chemotherapy nephrectomy cases were subdivided into three risk groups:low risk(n=0),intermediate risk(n=10)and high risk(n=2).Six post-chemotherapy resection cases were subdivided into 3 risk groups:low risk(n=0),intermediate risk(n=5)and high risk(n=1).The remaining 11 cases were comprised of metastatic,relapse,and post-chemotherapy metastatic lesions.The concordance rate of the two senior pathologists was 100%(91/91).Conclusions The 2019 revision of"CCCG-WT-2016"is clearly written and easy to use.It can serve as the basis of accurate classification for clinical treatment.

关 键 词：WILMS瘤 病理学 临床 危险 

分 类 号：R737[医药卫生—肿瘤]