Different Treatment Modalities Influence Of Pediatric Nephroblastoma Prognosis

Objective:By analyzing the 137 cases of Wilm's Tumors treated children with Wilm's tumor at different times of the clinics,comparison and analysis of the efficacy of prognosis of children Nephroblastoma treatment methods and its impact on the prognosis of the relevant factors,I studied the diagnoses and treatments of Wilm's tumor in children(by stage and histology in accordance with National Wilm's Tumor Study criteria of USA), and investigated the prognostic factors of Wilm's Tumor in order to bring more relevance and effectiveness clinical diagnosis and treatment of Wilms' Tumor and to provide more experiences to the improvement of prognosis.Method:137 cases of Wilm's Tumors in children from 1976-2004 were retrospectively analyzed and follow-up,M 85 cases,52 cases of female,aged 2 months -14 years old,with an average age of 3.3 years old,The clinical stages which basis on the clinical stage standard by NWTS-5 as follows: PhaseⅠ-32 cases;PhaseⅡ-28 cases;PhaseⅢ-49 cases;25 patients with stageⅣ,Ⅴ-3cases,according to the different age and different treatment methods, it is divided into three phases:Group A:Surgery+single-agent chemotherapy+radiotherapy;Group B:Surgery+combined with chemotherapy+radiotherapy,in part(70%)patients completed standardized chemotherapy;Group C:Preoperative chemotherapy surgery+ surgery+combined with chemotherapy+radiotherapy,Group C which preoperative chemotherapy treatment in accordance with the different methods of intervention can be divided into Transcatheter A rterial Chemoembolization group(C1)and preoperative systemic intravenous chemotherapy group(C2).The histological type and the stage of each case in each phase were in accordance with the clinical pathological stage adopted by Wilm's Tumor Study Group(NWTS).According to its history,it is divided into favorable histology(FH),unfavorable histology(UH),clear cell-sarcoma of kidney(Cs)and malignant rhomboid tumor of kidney(Rs),to contrast the difference among the survival rate of each phases of the same history,and use the statistical analysis to comprehend whether there was a statistical significance;According to its clinical stage it is divided into PhaseⅠ-Ⅴ,to contrast the difference among various phases of the same stage,and use the statistical analysis to comprehend whether there was a statistical significance.To compare with the Treatment standards of Wilm's Tumor of NWTS,I analyzed the reasons for the difference and the influencing factors of the prognosis.Result:①There was a total of 137 cases in the group,111 cases were followed up rate of 79.9%,up for 4-20 years。②On the A,B,C group than for a period of balanced analysis,P=0.644＞0.05,the component ratio of the group staging the difference was not significant.③C1 and C2 groups of the various constituent ratio of a balanced analysis,P=0.748＞0.05,the component ratio of two phases without statistical significance.④On the A, B,C,the survival rate comparison group,by several rank test,P=0.002＜0.05,the difference is statistically significant.⑤Group b and c groups surgical resection rates were 70.7%,91.7%,compared to 0.043,P＜0.05,the difference is statistically significant.⑥C1 and C2 of the group to compare survival group,P=0.045＜0.05,the difference is statistically significant.⑦FH-survival rate was 76.6%(72/94),the UH-survival rate was 35.2%(6/ 17),by several rank test(log-rank test),P=0.001＜0.05,the difference is statistically significant.Conclusion:①Reasonable comprehensive therapeutic especially the regular chemotherapy can significantly enhance the survival rate of nephroblastoma.②Preoperative chemotherapy could significantly increase the rate of tumor resection,raising children,especially children with the late improve the prognosis of patients with important significance.③Preoperative chemotherapy interventional remobilization than systemic chemotherapy more radical surgery to obtain better outcomes,increase the survival rate.④It's demonstrated that histopathologic type and clinical stages are important prognostic factors for Wilm's Tumor early diagnosis and early surgical is favorable to improve prognosis.