61例儿童肾母细胞瘤的诊断治疗与随访

目的 评价不同因素对儿童肾母细胞瘤生存率的影响，以期更合理地选择治疗方式，进一步改善患儿预后。方法 回顾性分析上海交通大学医学院附属新华医院儿童血液/肿瘤科2007年1月—2012年12月收治的61例肾母细胞瘤病例，采用Kaplan-Meier生存分析法对临床资料进行统计分析。结果 61例患儿中，男童41例，女童20例，4年预期总体生存率为91.8%。各临床分期4年预期总体生存率Ⅰ＋Ⅱ期为100%，Ⅲ期为90.5%，Ⅳ＋Ⅴ期为78.6%，晚期肾母细胞瘤生存率明显低于早期组，而肿瘤残留或破溃组患儿的生存率较无瘤组明显降低（4年总体生存率：82.6% vs 97.4%，P〈0.05）。结论 儿童肾母细胞瘤的总体预后良好，规范的多学科联合诊治模式改善了该病的预后，临床分期和肿瘤是否残留或破溃是重要的预后因素。

Diagnosis,treatment and follow-up of 61 children with nephroblastoma

Objective To evaluate the effects of different factors on the survival rate of children with nephroblastoma so as to choose treatment methods more reasonably and to improve the prognosis of patients. Methods Sixty-one nephroblastoma cases admitted by the Department of Pediatric Hematology/Oncology of Xinhua Hospital from Jan. 2007 to Dec. 2012 were retrospectively analyzed and the clinical data were statistically analyzed by the Kaplan-Meier process. Results Among 61 cases, 41 cases were male and 20 cases were female. The expected 4-year overall survival rate was 91.8%. The expected 4-year overall survival rates of stageⅠ＋Ⅱ, stage Ⅲ, and stage Ⅳ＋Ⅴ were 100%, 90.5%, and 78.6%, respectively. The survival rate of late stage of nephroblastoma was significantly lower than that of the early stage. The survival rate of patients who had residual or ulcerated tumors was significantly lower than that of tumor-free patients （4-year overall survival rates of 82.6% and 97.4%, P〈0.05）. Conclusion The overall prognosis of children with nephroblastoma is good. The normative multi-discipline combined treatment can improve the prognosis. Clinical staging and whether tumors are residual or ulcerated are important prognosis factors.