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

MA Wei; SHI Qinlin; TIAN Xiaomao; LU Peng; LIU Feng; LIU Xing; HE Dawei; LIN Tao; WEI Guanghui

doi:10.16016/j.1000-5404.202011052

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

更新时间：2021-08-02

- Effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor
- Journal of Army Medical University Vol. 43, Issue 9, Pages: 858-862(2021)
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202011052
  CLC： R322.27;R195.4;R737.11
- Published：2021，
  
  Published Online：15 May 2021，
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[1]马伟,石秦林,田小毛,等.淋巴结受累与取样数目对肾母细胞瘤患儿预后的影响[J].陆军军医大学学报(原第三军医大学学报),2021,43(09):858-862.MA Wei,SHI Qinlin,TIAN Xiaomao,et al.Effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor[J].J Amry Med Univ (J Third Mil Med Univ),2021,43(09):858-862.

MA Wei, SHI Qinlin, TIAN Xiaomao, et al. Effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor. [J]. Journal of Army Medical University 43(9):858-862(2021)
[1]马伟,石秦林,田小毛,等.淋巴结受累与取样数目对肾母细胞瘤患儿预后的影响[J].陆军军医大学学报(原第三军医大学学报),2021,43(09):858-862.MA Wei,SHI Qinlin,TIAN Xiaomao,et al.Effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor[J].J Amry Med Univ (J Third Mil Med Univ),2021,43(09):858-862. DOI： 10.16016/j.1000-5404.202011052.

MA Wei, SHI Qinlin, TIAN Xiaomao, et al. Effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor. [J]. Journal of Army Medical University 43(9):858-862(2021) DOI： 10.16016/j.1000-5404.202011052.

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。Pearson χ2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<0.000 1）。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<0.000 1），在预后良好型（FH型）患儿中分别为73.33% vs 84.16%（P=0.091 8）。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<0.000 1）。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=0.479 0）。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。

Abstract

ObjectiveTo investigate the effects of lymph node involvement and dissection number on prognosis in patients with Wilms tumor (also known as nephroblastoma). MethodsClinical 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. ResultsA 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<0.000 1). Moreover

the ratio for those with unfavorable histology (uFH) was 25.00% and 71.13% (P<0.000 1)

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=0.091 8). 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<0.000 1). There was no significant correction between the dissection number and prognosis in the stage Ⅰ and stage Ⅱ patients (P=0.479 0). ConclusionLymph 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

Keywords

nephroblastomaWilms tumorlymphadenectomyprognosis

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