The Clinical Study Of Outcome And Impact Factors For Wilms’ Tumor Treated With Preoperative Chemotherapy

Objective1. To evaluate the outcome of Wilms’ tumor treated with the preoperative.2. To determine the indications for preoperative chemotherapy and provide evidence for the curative effect that predicted before chemotherapy by analysing the possible factors that affect the outcome in Wilms’tumor treated with preoperative chemotherapy.MethodsFrom January 2009 to March 2015, a total of 56 patients (58 sides) with Wilms’ tumor were enrolled in this study, selected from 170 patients (172 sides) who were pathologically confirmed Wilms’ tumor and meeting the following standards:1) Massive Wilms’ tumor with any one of the following items ① The imaging showed that the tumor’s boundary was not clear or ruptured; ② Great vessels enrolled; ③ Closed to vital organs,and unable to be resected by surgery.2) Massive Wilms’ tumor with distant metastases.3) Bilateral Wilms’ tumors. Evaluate the tumors’ longest diameter by ultrasound and CT, then calculate every tumor’s volume by the current formula πabc/6. Analyze the shrink rate of tumor, defined<15%、15%-30%,30%-50% and>50% as no responders, poor responders, good responders and very good responders respectively Using SPSS19.0 to analysize the outcome and possible factors that affect the chemotherapy such as age, histologic subtypes, clinical stage, initial tumor volume and whether tumor ruptured or necrosised ect.Results1. In the 56 cases (58 sides), the largest, minimum and average volume was 5774.6 ml,54.3 ml and 981.4 ml respectively. The initial tumor volume less than 500 ml was bilateral or distant metastasis. After preoperative chemotherapy, the average tumor volume shrinked to 757.5 ml with the rate of 23%.After chemotherapy, a total of 44 cases (76%) shrinked, and 39 cases (67.2%) were shrinked more than 15%.2.20 of the 56 cases had tumor metastases, after preoperative chemotherapy, it disappeared in 7 cases and shrinked in 7 cases. there were 10 cases with intravascular extension, disappeared in 5 cases, shrinked in 2 cases after chemotherapy; 4 cases with liver metastasis, disappeared in 2 cases, shrinked in 1 case after chemotherapy;4 cases with pulmonary metastasis, shrinked in 2 cases after chemotherapy; Vertebral metastasis and lymph node metastasis in 1 case respectively, both shrinked after chemotherapy3. The outcome and impact factors for Wilms’ Tumor Treated with Preoperative Chemotherapy1) The association of the ageIn different age groups,the effective rate of preoperative chemotherap y in infant period, toddler period, preschool and school age were respective ly 50%,63%,75% and 100%. The result showed that comparing with infan t period group, except for the toddler period,the other two groups, prescho ol and school age group were significantly improved, which indicated that the chemotherapeutic effect improved with age increased.2) The association of the histological subtypesThere were 48 sides FH and 10 sides UFH (including Clear-cell sarcoma of the kidney, CCSK) postopration, the effective rate were 70.8%,50% respectively. Though no significant difference was found between them, the effective rate of FH is higher than UFH. In FH, the curative effect of epithelial type is best, its effective rate was 100%, significant difference was found when compared with others. In UFH,the effective rate of anaplastic type was 75%, higher than CCSK, which effective rate was 33% only.3) The association of the initial tumor volumeThere was no association in the initial tumor volume and curative effect of preoperative chemotherapy.4) The association of the necrosis in the tumorAccording to CT and ultrasound, this group with necrosis is 46 (79.3% ),31 responders (67.4%);No obvious necrosis,12 (20.7%),8 case(66.7%) responders, There is no significant difference between them (P> 0.05).The re is no obvious correlation between the necrosis or not and and the curative effect of the pre-oprative chemotherapy.5) The association of the tumors rupture:According to the tumor whether ruptured founded in intraoperative, they were divided into two groups, including no ruptured cases of 34 (58.6%),23(68%) responders; ruptured cases of 24 (41.4%), 17(71%)responders. There was no obvious correlation between them, P> 0.05.6) The association of the tumors stageAfter opration, there were 23 cases (41.1%) in StageⅠ,10cases(17.9%) in Stage Ⅱ,12 cases (21.4%) in Stage Ⅲ,9 cases (16.0%) in Stage IV,2 cases (3.6%) in Stage V The tumors were massive and infiltrated before operation.There were 20 cases (33%) with distant metastasis,much of them is in Stage Ⅲ、Ⅳor Ⅴ. However, there were 23 cases (41.1%) in stage 1 after chemotherapy and 10 cases (17.9%) in Stage Ⅱ. Confirmed that pre-oprative chemotherapy can lower the clinical stage significantly.Conclusions1. Preoperative chemotherapy can reduce the volume of nephroblasto ma, which is benefit for the opration.2. Preoperative chemotherapy can also have effect to these patients who have metastasis, especially with vena cava extensions or liver metastasis3. in the factors of the pre-oprative curative effect, ①here was a little significant in the age, the elder of the patients were, the better of the curative effect; ② the curative effect of FH is better than UFH,and the epithelial type is best in all types,CCSK is worst. ③ There was no relationships in the curative effect of the preoperative chemotherapy and the initial tumor volume, tumor with necrosis or not, tumor ruptured or not;④ Pre-oprative chemotherapy can down the stage of the tumor.