从粗略检查到报告 Wilms 肿瘤,重点关注治疗无效标本和化疗后标本的正确取样及其与预后的临床病理学相关性。

IF 0.7 Q4 UROLOGY & NEPHROLOGY
Urology Annals Pub Date : 2024-01-01 Epub Date: 2024-01-25 DOI:10.4103/ua.ua_60_23
Mohan Krishna Pasam, B Vishal Rao, Sai Kiran Chaganty, Rakesh Manilal Sharma, Veerendra Patil, Suseela Kodandapani, Sundaram Challa, Subramanyeshwar Rao Thammineedi
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引用次数: 0

摘要

背景:目的:分析影响未接受治疗和化疗后Wilms肿瘤标本预后的各种临床病理参数:这是一项回顾性观察研究:将纳入 2012 年至 2018 年期间在我院确诊的所有 Wilms 肿瘤患者,并提供其临床结果、实验室报告和放射学结果。根据所使用的治疗方案(儿科肿瘤学会(SIOP)或国家威尔姆斯肿瘤研究组/儿童肿瘤学组(COG)指南),将患者分为两组。将分析治疗前和治疗后标本的毛细和报告方案的细节。将对截至 2020 年 12 月的随访情况进行分析:统计分析采用卡方检验和费雪精确检验:本研究共纳入 36 名确诊为 Wilms 肿瘤的患者。平均发病年龄为(3.9±0.7)岁,男性多于女性。大多数患者表现为腹部肿块,少数患者伴有孤立性血尿。26例(72%)患者按照SIOP方案接受了术前新辅助化疗。10名患者按照COG方案进行了前期手术。SIOP 组患者的平均肿瘤大小为 9.3 厘米。40%的患者(10 人)为混合组织学类型,其次是胚芽组织类型(32%,8 人)。退行性和上皮性组织学类型分别占 16%(4 人)和 12%(3 人)。在 SIOP 组中,72%(n = 19)无增生,28%(n = 7)有增生。57%(n = 15)的病例为Ⅰ期,26.9%(n = 7)和11.5%(n = 3)的病例分别为Ⅱ期和Ⅲ期。10名患者按照COG方案接受了前期手术。这组患者的肿瘤平均大小为 8 厘米,从 7 厘米到 11 厘米不等。其中八例(80%)的组织学状况良好,两例出现局灶性增生。3例(70%)出现异源分化。在 10 例病例中,1 例为Ⅰ期,6 例为Ⅱ期,1 例为Ⅲ期,2 例为临床Ⅳ期。无一例出现血管或淋巴结转移。所有患者在手术后都接受了辅助化疗,并随访至 2020 年 12 月(至少 3 年)。在 SIOP 组的 25 名患者中,18 人(72%)的病情完全缓解,且没有残留疾病的放射学证据。在COG组的10名患者中,6名(70%)完全缓解:Wilms肿瘤的组织病理学评估是治疗Wilms肿瘤的关键环节,因为在SIOP和COG方案下治疗的肿瘤特征不同,这将最终影响预后风险分层。因此,有必要了解这两种方案下这些肿瘤的重要大体检查和报告方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Grossing to reporting of Wilms tumor with emphasis on proper sampling in treatment-naive and postchemotherapy specimens and their clinicopathological correlation with outcome.

Context: Emphasis on grossing to reporting for the assessment of histopathological parameters predicting outcomes in Wilms tumor.

Aims: To analyze various clinicopathological parameters that effect outcomes in treatment naïve and post chemotherapy Wilms tumor specimens.

Settings and design: This was a retrospective observational study.

Subjects and methods: All patients diagnosed with Wilms tumor between 2012 and 2018 at our institute will be included with their clinical findings, laboratory reports, and radiological findings. The patients will be categorized into two groups based on treatment protocol (Society of Pediatric Oncology (SIOP) or the National Wilms Tumor Study Group/Children's Oncology Group (COG) guidelines) used. Details of Grossing and reporting protocols used for the in pre treatment and post treatment specimens will be analyzed. Follow-up till December 2020 will be analyzed.

Statistical analysis used: Chi-square and Fisher's exact tests were used for statistical analysis.

Results: A total of 36 patients with the diagnosis of Wilms tumor were included in the present study. The mean age of presentation was 3.9 ± 0.7 years, and males were more common than females. Most of them presented as abdominal mass and few with isolated hematuria. Twenty-six (72%) patients were treated under SIOP protocol with preoperative neoadjuvant chemotherapy. Ten patients underwent upfront surgery as per COG protocol. In SIOP group patients, the mean tumor size was 9.3cm. Forty percent (n = 10) we mixed histological type followed by blastemal type constituting (32%, n = 8). Regressive and epithelial histological types constituted 16% (n = 4) and 12% (n = 3), respectively. In the SIOP group 72% (n = 19) had no anaplasia and 28% (n = 7) had anaplasia. Fifty seven percent (n = 15) cases were Stage I, followed by 26.9% n = 7) and 11.5% (n = 3) being Stage II and Stage III, respectively. Ten patients underwent upfront surgery as per COG protocol. The mean tumor size among this group was 8 cm ranging from 7 cm to 11 cm. Eight (80%) cases had favorable histology and two cases showed focal anaplasia. Heterologous differentiation is seen in 3 (70%). Out of the 10 cases, one case was Stage I, six were Stage 2, one was Stage III, and two were clinical Stage IV. None of the cases showed either vessel or lymph node metastasis. All the patients received adjuvant chemotherapy postsurgery and were followed up till December 2020 for (at least 3 years). Of 25 patients in the SIOP group, 18 (72%) had complete remission with no radiological evidence of residual disease. Of the 10 patients in the COG group, 6 (70%) had complete remission.

Conclusions: Histopathological evaluation of Wilms tumor is a critical aspect in the management of Wilms tumor, as tumor characteristics are different in the tumors treated under SIOP and COG protocols, which will ultimately affect the prognostic risk stratification. This necessitates the knowledge of the important grossing and reporting of these tumors under the two protocols.

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Urology Annals
Urology Annals UROLOGY & NEPHROLOGY-
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31 weeks
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