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

Background

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.

Patients

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.

Results

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.

Conclusions

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.