CAJ | 학술논문

目的探讨肾母细胞瘤的综合治疗模式,提高肾母细胞瘤的疗效. 方法回顾性分析1981年7月至2010年6月55例肾母细胞瘤患者资料.术前超声引导下细针穿刺活检确诊18例,术后病理确诊53例.其中Ⅰ期7例,Ⅱ期19例,Ⅲ期21例,Ⅳ期6例,Ⅴ期2例；35例有组织学分型,其中预后良好型30例,预后不良型5例.55例患者中,行肾脏肿物切除术48例,局部扩大切除术2例,双肾肿瘤剜除术1例,肾肿物切除术加肺转移灶切除术2例,2例未行手术治疗；术前化疗18例,术后化疗40例,术后放疗12例.根据年龄、分期、组织分型、治疗方式、治疗时间段及是否放疗分组,应用Kaplan-Meier法比较各组3年和5年总生存率、2年无病生存率及1年无复发生存率,分析各分组因素与肾母细胞瘤预后的关系. 结果 55例患者治疗后3年和5年总生存率及2年无病生存率分别为77.6％、69.0％和52.4％,不同分期对总生存率(P=0.006)、单纯手术与综合治疗对无病生存率(P =0.004)、是否放疗对无病生存率(P=0.03)影响有统计学意义(P＜0.05). 结论规范的多学科协作的综合治疗模式可以显著提高肾母细胞瘤疗效.
목적 탐토신모세포류적종합치료모식,제고신모세포류적료효. 방법 회고성분석1981년7월지2010년6월55례신모세포류환자자료.술전초성인도하세침천자활검학진18례,술후병리학진53례.기중Ⅰ기7례,Ⅱ기19례,Ⅲ기21례,Ⅳ기6례,Ⅴ기2례；35례유조직학분형,기중예후량호형30례,예후불량형5례.55례환자중,행신장종물절제술48례,국부확대절제술2례,쌍신종류완제술1례,신종물절제술가폐전이조절제술2례,2례미행수술치료；술전화료18례,술후화료40례,술후방료12례.근거년령、분기、조직분형、치료방식、치료시간단급시부방료분조,응용Kaplan-Meier법비교각조3년화5년총생존솔、2년무병생존솔급1년무복발생존솔,분석각분조인소여신모세포류예후적관계. 결과 55례환자치료후3년화5년총생존솔급2년무병생존솔분별위77.6％、69.0％화52.4％,불동분기대총생존솔(P=0.006)、단순수술여종합치료대무병생존솔(P =0.004)、시부방료대무병생존솔(P=0.03)영향유통계학의의(P＜0.05). 결론 규범적다학과협작적종합치료모식가이현저제고신모세포류료효.
Objective To assess the effectiveness of the combined treatment model for Wilms'tumor and to improve treatment results. Methods Fifty-five patients diagnosed with Wilms' tumor between July 1981 to June 2010 were analyzed retrospectively.Eighteen patients were diagnosed by preoperative ultrasound-guided fine needle biopsy,and 53 patients were confirmed by postoperative pathology results.Seven cases were in clinical stage Ⅰ,19 cases in clinical stage Ⅱ,21 cases in stage Ⅲ,six cases in stage Ⅳ and two cases in stage Ⅴ.Thirty-five cases had histopathological subtype,30 cases had the favorable type,and five cases had the unfavorable type.Among the 55 patients,kidney tumor resection was performed on 48 cases,wide edge partial nephrectomy was performed on two cases,tumor enucleation was performed on one bilateral renal tumor case,kidney tumor resection with pulmonary metastasectomy was performed on two cases,and two cases had no surgical procedures.Eighteen cases received preoperative chemotherapy,40 cases received postoperative chemotherapy,and 12 cases received postoperative radiotherapy.Patients were grouped according to age,stage,histological type,treatment model,treatment course and whether or not they had radiotherapy.The Kaplan-Meier method was used in the evaluation and comparison of over survival (OS),disease free survival (DFS) and relapse free survival (RFS) of the different groups to reveal the relationship between different grouping factors with the prognosis of Wilms' tumor. Results The median of follow-up was 34 mon ( ranging from 3 to 355 mon).The 3-year OS,5-year OS and 2-year DFS were 77.6％,69.0％ and 52.4％,respectively.The differences of OS in different stages ( P =0.006 ),DFS between pure operation group and combined therapy group ( P =0.004 ) and RFS between radiotherapy group and no radiotherapy group ( P =0.03 ) were significant,P ＜ 0.05. Conclusions The normative multi-disciplinary treatment model for patients with Wilms' tumor can achieve good results and is well tolerated.