Factors responsible for stage III disease in patients with Wilms tumor enrolled in the JWiTS-2 study
Factors responsible for stage III disease in patients with Wilms tumor enrolled in the JWiTS-2 study
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参与 JWiTS-2 研究的肾母细胞瘤患者 III 期疾病的影响因素
DOI：
10.1007/s00383-019-04531-z
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发表时间：
2019
影响因子：
1.8
通讯作者：
Koshinaga T
中科院分区：
文献类型：
--
作者：
Oue T;Fukumoto K;Souzaki R;Takimoto T;Koshinaga T
背景/目的III期肾母细胞瘤（WT）的治疗比I期和II期非转移性WT更密集。包括肿瘤溢出、不可切除性和淋巴结转移在内的各种因素是导致III期疾病的原因。本研究的目的是不确定与III期WT的功能，以建立新的治疗strategy.Design/methodsOf 166例非转移性WT在日本肾母细胞瘤研究（JWiTS）-2，51例患者的临床因素有III期疾病。JWiTS-2的治疗方案与国家Wilms肿瘤研究（NWTS）-5中的治疗方案基本相同。当地医院进行了调查，收集有关III期疾病的临床表现的细节，并获得了45（88%）patients.Results9例巨大的肿瘤进行术前化疗的数据。6例行活检。9例中8例肿瘤缩小。最终均行肾切除术。36例患者接受了原发性肾切除术。III期疾病的原因是淋巴结转移（n= 9，25%），肿瘤溢出（n= 20，56%）和肿瘤扩展/不完全切除（n= 17，47%）。有些患者有不止一个这些因素。大多数患者接受DD-4A方案治疗，45例患者中有43例（95.6%）接受了腹部放射治疗。肿瘤复发3例（局部，1;转移，2），2例患者死亡。总生存率和无复发生存率分别为95.2%和90.8%。在下一阶段，化疗和放疗的剂量应减少，以避免迟发效应。原发性切除术后肿瘤溢出率高，提示对于有手术风险的大肿瘤病例，应开始术前化疗，而不是积极的肿瘤切除
Background/objectivesTreatment is more intensive for stage III Wilms tumor (WT) than for stages I and II non-metastatic WTs. Various factors including tumor spillage, unresectability, and lymph node metastasis are responsible for stage III disease. The present study aimed to not identify clinical factors associated with the features of stage III WT to establish new treatment strategies.Design/methodsOf 166 patients with non-metastatic WT enrolled in the Japan Wilms Tumor Study (JWiTS)-2, 51 patients had stage III disease. The treatment protocol for JWiTS-2 was essentially the same as that in the National Wilms Tumor study (NWTS)-5. Local hospitals were surveyed to collect details of clinical findings related to stage III disease, and data regarding 45 (88%) patients were obtained.ResultsNine patients with massive tumors underwent preoperative chemotherapy. Biopsy was performed in 6. Reduction in the tumor size was achieved in 8 of the 9 cases. Nephrectomy was finally performed in all of them. Thirty-six patients underwent primary nephrectomy. The reason for the stage III disease was lymph node metastasis (n= 9, 25%), tumor spillage (n= 20, 56%), and tumor extension/incomplete resection (n= 17, 47%). Some patients had more than one of these factors. Most patients were treated with the DD-4A regimen, and 43 (95.6%) of the 45 patients received abdominal radiation therapy. Tumors recurred in three patients (local, 1; metastasis, 2), and two patients died. Overall and relapse-free survival rates were 95.2% and 90.8%, respectively.ConclusionThe prognosis of stage III WT was good. In the next stage, the doses of chemotherapy and radiotherapy should be reduced to avoid late effects. The high rate of tumor spillage after primary resection suggests that preoperative chemotherapy should be started instead of aggressive tumor resection in the large tumor cases with surgical risks
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影响因子：
1.8
作者：
Oue, Takaharu;Fukuzawa, Masahiro;Tanaka, Yukichi
通讯作者：
Tanaka, Yukichi
影响因子：
6.2
作者：
G. D'angio;A. Evans;N. Breslow;B. Beckwith;H. Bishop;P. Feigl;W. Goodwin;L. Leape;L. Sinks;W. Sutow;M. Tefft;J. Wolff
通讯作者：
J. Wolff
影响因子：
8.4
作者：
Irtan, S.;Jitlal, M.;Pritchard-Jones, K.
通讯作者：
Pritchard-Jones, K.
影响因子：
45.3
作者：
Cohn, Susan L.;Pearson, Andrew D. J.;Matthay, Katherine K.
通讯作者：
Matthay, Katherine K.
基于影像的肾母细胞瘤手术危险因素
DOI：
--
发表时间：
2017
期刊：
Pediatric surgery international (Print)
影响因子：
--
作者：
T. Oue;A. Yoneda;N. Usui;Takashi Sasaki;Masahiro Zenitani;N. Tanaka;S. Uehara;S. Ibuka;Y. Takama;H. Okuyama
通讯作者：
H. Okuyama