多中心多学科综合治疗儿童肾脏恶性肿瘤的疗效分析

Clinical effect of multicenter multidisciplinary treatment in children with renal malignant tumors

摘要:

目的 分析多中心儿童肾脏恶性肿瘤多学科综合治疗（MDT）下的长期疗效。方法 收集2015年1月至2020年1月在湖南省3家医院经MDT流程诊治的55例肾脏恶性肿瘤患儿的临床资料，治疗方案参考GD-WT-2010和CCCG-WT-2016方案。采用Kaplan-Meier法对所有患儿进行生存分析。结果 55例患儿中，Ⅰ期10例，Ⅱ期14例，Ⅲ期22例，Ⅳ期7例，Ⅴ期2例；病理分型为FH 47例，UFH 8例。所有患儿均经手术完整切除肿瘤，25%（14/55）的患儿接受了术前化疗，除1例肾细胞癌外，所有患儿均接受术后化疗，其中有放疗指征患儿中68%（21/31）接受术后放疗。1例术后转移死亡。FH型骨髓抑制发生率94.4%，UFH型骨髓抑制发生率100%。所有患儿中位随访时间21个月，中位生存时间26个月，总生存率为98%，无事件生存率为95%。结论 多中心MDT治疗儿童肾脏恶性肿瘤，手术成功率高，化疗疗效好，毒副作用以骨髓抑制多见，放疗安全有效，不良反应少，具有较好的可行性、安全性和经济性。

Abstract:

Objective To study the long-term clinical effect of multicenter multidisciplinary treatment(MDT)in children with renal malignant tumors.Methods A retrospective analysis was performed on the medical data of 55 children with renal malignant tumors who were diagnosed and treated with MDT in 3 hospitals in Hunan Province from January 2015 to January 2020,with GD-WT-2010 and CCCG-WT-2016 for treatment regimens.A Kaplan-Meier survival analysis was used to analyze the survival of the children.Results Of the 55 children,10 had stage I tumor,14 had stageⅡtumor,22 had stageⅢtumor,7 had stage IV tumor,and 2 had stage V tumor.As for pathological type,47 had FH type and 8 had UFH type.All children underwent complete tumor resection.Of the 55 children,14(25%)received preoperative chemotherapy.All children,except 1 child with renal cell carcinoma,received postoperative chemotherapy.Among the 31 children with indication for radiotherapy,21(68%)received postoperative radiotherapy.One child died of postoperative metastasis.The incidence rate of FH-type myelosuppression was 94.4%,and the incidence rate of UFH-type myelosuppression was 100%.The median follow-up time was 21 months and the median survival time was 26 months for all children,with an overall survival rate of 98%and an event-free survival rate of 95%.Conclusions Multicenter MDT has the advantages of high success rate of operation and good therapeutic effect of chemotherapy in the treatment of children with renal malignant tumors,with myelosuppression as the most common side effects,and radiotherapy is safe and effective with few adverse events.Therefore,MDT has good feasibility,safety,and economy.