The contribution of chest CT-scan at diagnosis in children with unilateral Wilms鈥?tumour. Results of the SIOP 2001 study

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• 作者：Anne M.J.B. Smets^a ; ^{a.m.smets@amc.uva.nl} ; Harm van Tinteren^b ; Christophe Bergeron^c ; Beatriz De Camargo^d ; Norbert Graf^e ; Kathy Pritchard-Jones^f ; Jan de Kraker^g
• 关键词：Wilms&rsquo ; tumour ; Nephroblastoma ; Child ; Radiology ; Lung neoplasms ; Paediatric oncology ; Outcome ; Prognosis
• 刊名：European Journal of Cancer
• 出版年：2012
• 期刊代码：88_09598049
• 类别：med
• 出版时间：May, 2012
• 卷：48
• 期：7
• 页码：1060-1065
• 文件大小：201 K

摘要

<h4 class="h4">Backgroundh4>The SIOP 2001 nephroblastoma study hypothesised that patients with 鈥楥T-only鈥?pulmonary nodules would have the same outcome as patients with localised disease of same stage and histology.<h4 class="h4">Patientsh4>

Unilateral Wilms鈥?tumour (WT) patients, who had chest CT scans at diagnosis showing any sized pulmonary nodules undetected on chest X-ray, between November 2001 and November 2009, were selected from the SIOP 2001 database.<h4 class="h4">Resultsh4>

Among 2532 WT patients, 103 unilateral nephroblastoma patients with CT-only lung lesions were found. Thirty-seven patients received preoperative treatment according to the localised-disease protocol, and 66 according to the metastatic-disease protocol. The 3-year event-free survival (EFS) was 70%(95%CI: 55-89%) and 77%(95%CI: 66-89%), respectively. Corresponding 3-year overall survival (OS) was 89%(95%CI: 77-100%) and 85%(95%CI: 75-96%), respectively (m>pm>-value not significant). EFS and OS of all 2071 patients with true localised disease were 87%(95%CI: 86-89%) and 96%(95%CI: 94-97%), respectively. Patients with metastatic disease (m>nm> = 358) had 3-year EFS and OS estimates of 68%(95%CI: 63-74%) and 77%(95%CI: 72-82%), respectively.<h4 class="h4">Conclusionsh4>

EFS and OS of patients with CT-only lung lesions were inferior to that of true localised-disease patients and superior to that of patients with metastatic disease. However, no significant difference was found in EFS and OS between CT-only patients treated for localised or metastatic disease. The clinician鈥檚 preference to treat patients with CT-only pulmonary nodules as metastatic disease is not evidence-based. Chest CT at diagnosis does not improve outcome but presents paediatric oncologists with a difficult dilemma.