Renal neoplasms in adult survivors of childhood Wilms tumor
Renal neoplasms in adult survivors of childhood Wilms tumor
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DOI：
10.1016/s0022-5347(05)66283-0
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发表时间：
2001-06-01
影响因子：
6.6
通讯作者：
Novick, AC
中科院分区：
文献类型：
--
作者：
Cherullo, EE;Ross, JH;Novick, AC
目的：大型合作研究对儿童肾母细胞瘤幸存者进行了大约31年的随访。在这段时间里，在这些Wilms肿瘤幸存者中记录了一些第二恶性肿瘤，与一般人群相比，他们有更高的发展风险。据我们所知，在儿童肾母细胞瘤成功治疗的患者中，以前没有肾肿瘤的报道。材料和方法：我们回顾了4例在儿童时期接受根治性肾切除术和辅助治疗的成年肾母细胞瘤患者，他们在对侧肾脏出现复杂的囊性或实性肾肿块。参数包括患者在Wilms肿瘤诊断时的年龄、Wilms肿瘤的治疗方式、第二次恶性肿瘤出现时的年龄和切除的肾脏病变病理。我们进行了全面的文献回顾，以确定肾脏恶性肿瘤的发展为儿童肾母细胞瘤幸存者的第二恶性肿瘤。结果：国际儿科肿瘤学会和国家肾母细胞瘤研究对接受肾母细胞瘤治疗的患者进行了不超过31年的随访。肾肿瘤，包括2例肾细胞癌，1例癌细胞瘤和1例非典型囊肿，在34至50岁的相对年轻的成年人中，他们在31年前接受过肾母细胞瘤的治疗，在我们的机构成功地接受了部分肾切除术。国际儿科肿瘤学会和国家肾母细胞瘤研究都没有将肾母细胞癌确定为成功治疗肾母细胞癌患者的第二恶性肿瘤。结论：我们的经验表明，在大型多中心试验中尚未达到的年龄，有儿童肾母细胞瘤治疗史的相对年轻的成年人患肾脏肿瘤的风险可能会增加。在规划这些患者的长期随访时应考虑到这种可能性。发展这种类型的第二种恶性肿瘤的可能性再次提出了在患有肾母细胞瘤的儿童中进行原发性肾单位保留手术的临床问题。
Purpose: Survivors of childhood Wilms tumor have been followed by large collaborative studies for approximately 31 years. In this time a number of second malignant neoplasms have been documented in these Wilms tumor survivors and they are at higher risk for such development compared with the general population. To our knowledge no renal neoplasms have been previously reported in patients successfully treated for Wilms tumor in childhood.Materials and Methods: We reviewed the cases of 4 adults in whom Wilms tumor was treated in childhood by radical nephrectomy and adjuvant therapy and who presented to our institution with complex cystic or solid renal masses in the contralateral kidney. Parameters, including patient age at Wilms tumor diagnosis, Wilms tumor treatment modalities, age at second malignant neoplasm presentation and resected renal lesion pathology were outlined. A thorough literature review was performed to identify the development of renal malignancies as second malignant neoplasms in survivors of Wilms tumor in childhood.Results: The International Society of Pediatric Oncology and National Wilms Tumor Study have followed patients treated for Wilms tumor for no greater than 31 years. Renal neoplasms, including 2 renal cell carcinomas, 1 oncocytoma and 1 atypical cyst, in the solitary remaining kidney of relatively young adults 34 to 50 years old who were treated for Wilms tumor greater than 31 years ago were successfully treated with partial nephrectomy at our institution. Neither the International Society of Pediatric Oncology nor National Wilms Tumor Study has identified renal cell carcinoma as a second malignant neoplasm in patients successfully treated for Wilms tumor.Conclusions: Our experience suggests that relatively young adults with a history of childhood treatment for Wilms tumor may be at increased risk for renal neoplasms at ages not yet achieved by those enrolled in large multicenter trials. This possibility should be considered when planning the long-term followup of these patients. The potential to develop this type of second malignant neoplasm again raises the clinical issue of performing a primary nephron sparing procedure in children presenting with Wilms tumor.