| ObjectiveTo explore the clinical characteristics and prognostic factors of nephroblastoma in children.MethodsTo analysis the clinical characteristics, the prognostic factors of 73 children with nephroblastoma in Qilu hospital of Shandong University from January 2009 to December 2015. The clinical data was obtained through consulting medical records, and 55 patients were followed up by outpatient and ward visits and telephone follow-up. The gender, age, disease location,preoperative LDH value and prognosis matched chi-square test was adopted to analyze single factor, survival analysis use Kaplan-Meier method and Long-rank test.Results1. Among the 73 cases,47 cases were male(64.4%) and 26 cases were female(35.6%). The average age at onset was 2.8 years, and the median age was 2.3 years. There was 1 case(1.4%) with bilater nephroblastoma, and 72 cases(98.6%) with unilateral nephroblastoma. Among the latter,31 cases(42.5%) were in the right, and 42 cases were in the left. The prime clinical manifestations were abdominal mass(35 cases,47.9%), gross hematuria(17 cases,23.3%), bellyache (8cases,11.0%) and the other symptoms (13 cases,17.8%)2.64 children of them were received tumor resection or only biopsy, and typed with the NWTS-5 criteria. The pathology study reported that 53 cases(82.7%) favorable histology type(FH),3 cases(4.7%) unfavorable histology type(UH), and 1 case(1.6%) bilateral nephroblastoma, and 1 case was packet failure after chemotherapy. Among the UH children,5 cases(7.8%) were renal clear cell sarcoma, and 1 cases(1.6%) was renal rhabdomyosarcoma.3. Clinical staging was performed according to the NWTS-5 staging criteria. Among the 64 children, Stage I in 23 cases (35.9%),stage Ⅱ in 14 cases (21.9%),stageⅢ in 13 cases (20.3%), stage Ⅳ in 13 cases (20.3%), stage V in 1 cases (1.6%)。4. The treatment protoco (WT-2009) was draw up by Chinese Children Cancer Group. Among 64 patients,32 cases (50%)were in WT-2009(1) group, there were 18 cases (28.1%) in WT-2009(2) group,6 cases (9.4%) in WT-2009(3) group,5 cases (7.8%) in WT-2009(4) group, and 3 cases (4.7%) in WT-2009(5) group.5.There were 55 children with nephroblastoma in a long period of follow-up. There were 29 cases(52.7%) in complete remission group,2 cases(3.6%) in partial remission group,13 cases(23.6%) in recrudescence group, and 11 cases(20%) gave up for personal reason.6. By collecting the data, and using SPSS 19.0 software, we can find that there was no statistically significant difference in prognosis between the different sex, age of onset ,location of the nephroblastoma, and the different group in histological type, pathological stage and the LDH before operation has difference statistically in prognosis. The 2-year overall survival rate was 71.8%.Conclusions1.The proportion of male and female in children with nephroblasotma was no different, and the prognosis was not related to sex. The age of onset was early, and the main symptoms contained abdominal mass, gross hematuria, bellyache and so on.2.The histological type and pathological stage were the prognostic factors for nephroblastoma children. The favorable histology type(FH) was the commonest histological type, and it has a much better prognosis.3 The level of LDH before operation can partly reflected the prognosis of nephroblastoma. And we can long-term dynamically monitor the level of LDH after operation, as an index in the following survey.4. WT-2009 regiment combined surgery with radiochemotherapy. It was significantly effiective for the individualized therapeutic regimen according to the risk group to improving clinical prognosis and reducing mortality. |
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