The Study Of Clinical Characteristics And Related Factors Of Pulmonary Metastases In Children With Stage ? Nephroblastoma

PurposeTo investigate the risk factors of pulmonary metastases in children with stage IV Wilms tumor(WT),and to provide a basis for the assessment of prognosis;To summarize the survival of pulmonary metastases in children with stage IV WT,and to guide clinical treatment and medication.MethodsThe clinical data of 91 WT patients confirmed by pathologically in the general hospital of armed police forces from January 1,2006 to December 31,2016 were selected as the research object,including 55 males and 36 females,the median age of 26(3-144)months.All children were divided into localized nonmetastatic group and pulmonary metastases only group according to chest CT.The clinical data,including age,sex,place of onset,first symptom and tumor volume at the time of initial diagnosis,were collected and sorted out.Results1.Clinical data: In 91 cases of WT children,including lung metastasis in 18 cases(19.8%),11 males and 7 females,the median age of 45.5(6-144)months;There were73 patients(80.2%)without lung metastasis,44 males and 29 females with median age of 24(3-120)months.2.Univariate analysis: Age ? 24 months: There were 3 cases(16.7%)in the lung metastasis group and 39 cases(53.4%)without lung metastasis;> 24 months: There were 15 cases(83.3%)in the lung metastasis group,34(46.6%)without lung metastasis,P <0.05.Tumor volume ? 1000ml: Lung metastasis group 12 cases(66.7%),no lung metastasis group 26 cases(35.6%);<1000ml: Pulmonary metastasis in 6 cases(33.3%),non-pulmonary metastasis group of 47 cases(64.4%),P value <0.05.Postoperative staging: Lung metastasis group II,III 15 cases(83.3%);There were 39 patients(53.4%)with stage II and III without lung metastasis,P <0.05.In the sex,histopathological risk,the first symptoms(abdominal mass and other groups,such as hematuria,abdominal pain,fever,constipation,etc.)and the incidence of parts,P>0.05.3.Efficacy: Follow-up to December 31,2016,the mean survival of the lung metastases was 40.931(95% confidence interval,22.948-58.913 months);the mean survival of the patients without lung metastases was 103.539 months(95% confidence interval,90.799-116.279 months).Lung metastasis group 18 cases: 2 cases of CR,3 cases of PR,11 cases of PD death,2 cases were lost;No lung metastasis group 73 cases: 60 cases of CR,10 cases of recurrence(recurrence time more than half a year after the end of treatment),died in 12 cases(6 cases of recurrence death,PD death in 6 cases),1 case of heart failure died,1 case to give up treatment,5 cases were lost.Lung metastasis group of 18 patients died in 11 cases,the overall survival rate was 38.9%;there were 73 patients without lung metastasis and 13 patients died.The overall survival rate was 82.2%.The2-year OS(36.1%)in the lung metastasis group was lower than that in the non-pulmonary metastasis group(86.0%).ConclusionWT children with lung metastases were older than those without lung metastases;WT lung metastases in patients with newly diagnosed tumor volume,WT lung metastases in children with abdominal stage II,III were more common;WT lung metastases in children than the total survival rate of lung metastasis is low,there is a poor prognosis.