Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy - The United Kingdom experience
Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy - The United Kingdom experience
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DOI：
10.1016/j.ejca.2014.10.026
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发表时间：
2015-01-01
影响因子：
8.4
通讯作者：
Pritchard-Jones, K.
中科院分区：
文献类型：
--
作者：
Irtan, S.;Jitlal, M.;Pritchard-Jones, K.
基本原理：UKW 3试验比较了活检/术前化疗立即肾切除术，并提供了机会，以检查我们的腹膜后活检和其他因素对局部和远处复发的Wilms（WT）的影响。方法：单侧WT（阶段I-IV）排除异时性复发或疾病进展的患者有资格。对转移性和“不可手术的”肿瘤进行活检，“局部”定义为腹部复发，但肝转移除外，认为是“远处”复发，以及其他造血途径。单变量和多变量估计复发的危险因素。结果：总体而言，285/635（44.9%）例患者进行了活检。中位随访时间为10.1年，35例（5.5%）患者发生了“局部”复发，15例（2.4%）患者发生了联合复发，60例（9.4%）患者发生了“远处”复发。单变量分析显示，活检、间变性和肿瘤大小与局部复发风险增加相关。在多变量分析中，间变性和肿瘤对于局部复发仍然显著，而活检的风险升高（风险（HR）= 1.80：95%置信区间（CI）0.97-3.32，p = 0.060）是边际的。年龄，间变性，肿瘤大小，淋巴结转移和阶段，但不活检，分别与远处复发的风险增加，但只有年龄和间变性仍然显着以下多变量analysis.Conclusions：UKW 3试验提供了一些保证，活检不应该自动导致“upstaging”的WT。需要进一步评估这一有争议的领域。在一项多国试验中，英国（UK）继续常规活检所有患者的做法，而不是标准的欧洲方法，局部复发率的比较将提供这种机会，并计划。(C)2014爱思唯尔有限公司版权所有。
Rationale: The UKW3 trial compared biopsy/pre-operative chemotherapy immediate nephrectomy and afforded the opportunity to examine the influence of ous retroperitoneal biopsy and other factors on local and distant relapse of Wilms (WT).Methods: Patients with unilateral WT (stages I-IV) excluding metachronous relapse or progressive disease were eligible. Metastatic and 'inoperable' tumours were biopsied 'Local' was defined as relapse within the abdomen, except for liver metastases considered 'distant' relapse, together with other haematogenous routes. Uni- and multivariable estimated the risk factors for relapse.Results: Overall, 285/635 (44.9%) patients had a biopsy. With a median follow-up 10.1 years, 35 (5.5%) patients experienced a 'local', 15 a combined (2.4%) and 60 (9.4%) a 'distant' relapse. On univariate analysis, biopsy, anaplasia and tumour size were associated an increased risk of local relapse. On multivariable analysis, anaplasia and tumour remained significant for local relapse whereas the elevated risk of biopsy (hazards (HR) = 1.80: 95% confidence interval (CI) 0.97-3.32, p = 0.060) was marginal. Age, anaplasia, tumour size, lymph nodes metastases and stage, but not biopsy, were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis.Conclusions: The UKW3 trial provides some reassurance that biopsy should not automatically lead to 'upstaging' of WT. Further assessment of this controversial area is required. Comparison of local relapse rates in a multinational trial in which the United Kingdom (UK) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned. (C) 2014 Elsevier Ltd. All rights reserved.