淋巴结受累与取样数目对肾母细胞瘤患儿预后的影响  

Effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor

作　　者：马伟 石秦林 田小毛 陆鹏[1] 刘丰[1] 刘星[1] 何大维[1] 林涛[1] 魏光辉[1] MA Wei;SHI Qinlin;TIAN Xiaomao;LU Peng;LIU Feng;LIU Xing;HE Dawei;LIN Tao;WEI Guanghui(Department of Urology,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Children’s Hospital of Chongqing Medical University,Chongqing,400010,China)

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,儿童泌尿生殖发育与组织工程重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,重庆400010

出　　处：《第三军医大学学报》2021年第9期858-862,共5页Journal of Third Military Medical University

基　　金：国家临床重点专科项目[2013(544)]。

摘　　要：目的探究淋巴结受累与取样数目对肾母细胞瘤患儿预后的影响。方法采用回顾性队列研究,收集2010年1月至2019年12月在重庆医科大学附属儿童医院规范化治疗的肾母细胞瘤173例患儿的临床资料。根据淋巴结是否受累及取样数量分组,采用Kaplan-Meier生存函数描述生存结局,Log-rank检验比较组间患儿的5年无事件生存率(event-free survival,EFS)的差异。Pearsonχ2检验用于分类变量的比较。结果共173例患儿纳入研究,男性81例,女性92例,年龄1个月至13岁,发病中位年龄为2岁,中位随访时间53(3~108)个月。淋巴结受累与未受累患儿分别有23例(13.3%)和150例(86.7%),5年EFS分别为56.19%vs 81.27%(P<0.0001)。淋巴结受累与未受累患儿的5年EFS在预后不良型(uFH型)患儿中分别为25.00%vs 71.13%(P<0.0001),在预后良好型(FH型)患儿中分别为73.33%vs 84.16%(P=0.0918)。淋巴结取样数量为1~3个、4~6个、7~9个和超过10个的患儿中,淋巴结的阳性率分别为4.23%、7.32%、38.46%和43.75%(P<0.0001)。在Ⅰ期和Ⅱ期患儿中,淋巴结取样数量与患儿预后无显著关联(P=0.4790)。结论淋巴结受累是肾母细胞瘤患儿的不良预后因素,特别是在uFH型患儿中;淋巴结取样数量超过7个时发现阳性淋巴结的概率更大;但淋巴结取样数量与预后无关。Objective To investigate the effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor(also known as nephroblastoma).Methods Clinical data of all the children with Wilms tumor who received standardized treatment in our hospital from January 2010 to December 2019 were collected and retrospectively analyzed.The patients were divided into different groups according to lymph node involvement and sampling number.The survival outcome and 5-year event-free survival(EFS)among different groups were analyzed with Kaplan-Meier survival analysis and Log-rank test,respectively.Pearson’s Chi-squared test was used to compare categorical variables among groups.Results A total of 173 patients(81 boys and 92 girls)were enrolled in this study,with a median follow-up of 53(3~108)months.Among them,23 patients(13.30%)had lymph node involvement,and 150(86.70%)had not,and the ratio of 5-year EFS was 56.19%and 81.27%,respectively(P<0.0001).Moreover,the ratio for those with unfavorable histology(uFH)was 25.00% and 71.13%(P<0.0001),respectively,and that for those with favorable histology(FH)was 73.33% and 84.16%,respectively in the patients with or without lymph node involvement(P=0.0918).For the patients with dissected lymph node number of 1~3,4~6,7~9 and>10,the rate of positive lymph node was 4.23%,7.32%,38.46% and 43.75%,respectively(P<0.0001).There was no significant correction between the dissection number and prognosis in the stageⅠand stageⅡpatients(P=0.4790).Conclusion Lymph node involvement is a poor prognostic factor in patients with Wilms tumor,especially in those with uFH.The probability of detecting positive lymph node is higher when the number of dissected node larger than 7,but the dissection number has no effect on prognosis.

关 键 词：肾母细胞瘤 Wilms肿瘤 淋巴结清扫 预后 

分 类 号：R195.4[医药卫生—卫生统计学] R322.27[医药卫生—卫生事业管理]