| BackgroundWilms' tumor is one of the most common solid malignancy, and is the first place in renal tumor. It occurs mostly in children under 3 years old. Although there are no obvious symptoms at its early stage, Wilms' tumor growths so rapidly that it is normally difficult to be excised thoroughly and thus the patients have a bad prognosis. As treatment guidelines have established combining surgery, radiotherapy, and chemotherapy, especially preoperative chemotherapy, dramatic improvement has occurred in prognosis of Wilms' tumor, especially in advanced ones. Survival rate of Wilms' tumor increased markedly., Although higher survival rate has acquired in hepatic tumor in adult with the application of transcatherter arterial chemo-embolization (TACE) technique, it is few reported in Wilms tumor. The aim of TACE procedure is to reduce tumor vascularity with a resultant decrease in tumor mass improved tumor contours, easier nephrectomy and minimal intraoperative bleeding, andthe risk of intraoperative malignant cell spillage into the bloodstream that results in the metastasis will be greatly reduced. TACE is also useful in differential the diagnosis.Proliferating cell nuclear antigen (PCNA) exists in the nucleolus of cell and is an important index to the activity of cell proliferation. Expression of PCNA plays a significant role in the emergence and development of Wilms' tumor.Vascular endothelial cell factor (VEGF) is one of the most important angiogenic factors that increase vascular permeability. VEGF stimulates capillary formation and has mitogenic effects on vascular endothelial cells. ObjectiveThis content is to study the effect of preoperative transcatherter arterial chemo-embolization on Wilms' tumor, and to know the feasibility of TACE therapy for the children with Wilms' tumor, the side effect, degeneration of tumor cell. The expression of PCNA and VEGF were detected and compared between two groups. Methods41 cases of Wilms' tumor that were diagnosed after abdominal Ultrasonography (US), computed tomography (CT) and/or intravenous urography IVU examination were collected. The patients were divided into two groups: 23 cases (therapy group) were performed TACE and then operated 2 weeks later. The rest were operated directly without TACE. At the time of diagnosis, six patients were stage I , three were stage III, one was stage IV and the rest were not staged because of too large mass in TACEgroup. Eight patients were stage I , nine were stage II, two were stage III,and five patients could not be staged either with the same reason as TACE group in control group. All patients were confirmed by pathological examination of excised tumor.TACE technique: With the Seldinger percutaneous puncture and catheterization technique, plain abdominal aortography and selective renal arteriography readily perform and reveal the typical finding of pathologic vascularity. They also estimate tumor localization, size and extent of surrounding tissue invasion. Then the renal artery of tumor was embolized with the compound of adrimycin (20mg/m2) , iodized oil (0.5mg/kg) and gelatin sponge. The average time of TACE was 92 minutes. Nephrectomy was performed 2 weeks later.Clinical observation and following up: clinical symptom, white cell count, liver and kidney function analysis, electrocardiogram and tumor volume change pre- and post-TACE were observed. Whole tumor removal rate and 2-years relapse-free survival rate were compared between two groups.Histology and immunohistochemistry: to observe the degeneration of tumor cell, such as necrotic, fragmentized and disappeared tumor call according to the Tepper criterion. A comparative analysis of the pathological finding was made in two groups, and monoclonal antibodies were used to detect the expression of PCNA and VEGF in tumor tissue.Results1. TACE procedure was succeeded in all two groups without serious side effects. The average time of procedure was 92 minutes. About 2 weeks later shrinkage of tumor volume was 35.6%,...
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