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目的探讨建立儿童肿瘤协作组可能性,改善我国儿童肾母细胞瘤预后。方法在中国小儿肿瘤协会下建立儿童肿瘤协作组,制定儿童肾母细胞瘤WT-2003协作方案,方案包括诊断与分期标准,分组标准、各组包括外科手术、内科化疗、选择性放疗的治疗规则。协作组WT-2003方案先在上海儿童医学中心试行20例,证明安全性和有效性后2003年起在协作组内应用。根据患儿分组术后接受18~24周不同强度化疗。方案规定I期及II期病理分型为预后良好型不放疗,其余病例治疗均包含有手术、不同强度的放疗和化疗,估计手术不能完全切除时给予2个疗程术前化疗。结果15家医院参加协作组,7家医院上报汇总资料,累计病例52例。最大年龄12岁,最小6个月,中位29个月。病理分型为预后良好型(FH)35例,预后不良型(UFH)8例,透明细胞肉瘤(CS)5例,肾未分化肉瘤(US)2例,横纹肌样肉瘤(RS)1例,典型肾母细胞瘤特征影像学诊断1例(拒绝手术)。分期:I期17例,II期11例,III期17例,IV期6例,V期1例。48例获完全缓解,占92.3%。目前无肿瘤生存45例,占本组病例的86.5%,时间为3~72个月,中位13个月。结论中国儿童肿瘤多中心协作临床研究有可行性,通过这一方式可较快积累病例,使治疗更合理,提高我国儿童肿瘤整体诊治水平,本组患儿所采用诊断治疗方案有效,安全性好。
Objective To explore the possibility of establishing a cooperative group of children with cancer and to improve the prognosis of children with nephroblastoma in China. Methods A pediatric neoplasm group was set up under the China Society of Pediatric Oncology to develop a collaborative protocol for childhood nephroblastoma WT-2003. The protocol included diagnosis and staging criteria, grouping criteria, treatment rules for each group including surgery, internal medicine chemotherapy, and selective radiotherapy . The collaborative group of WT-2003 program first piloted in Shanghai Children’s Medical Center 20 cases, to prove the safety and effectiveness since 2003 in the collaboration group within the application. According to the group of children undergoing 18 ~ 24 weeks after the different intensity of chemotherapy. The protocol stipulates that stage I and II pathological classification is good prognosis without radiotherapy, and the remaining cases include surgery and different intensity of radiotherapy and chemotherapy. It is estimated that 2 courses of preoperative chemotherapy are given when the surgery can not be completely removed. Results 15 hospitals participated in the collaborative group, and 7 hospitals reported the summary data, accumulating 52 cases. The maximum age is 12 years old, minimum 6 months, median 29 months. There were 35 cases with good prognosis (FH), 8 with poor prognosis (UFH), 5 with clear cell sarcoma (CS), 2 with undifferentiated sarcoma (US), 1 with rhabdomyosarcoma (RS) A typical case of nephroblastoma imaging diagnosis (rejection surgery). Staging: 17 cases of stage I, 11 cases of stage II, 17 cases of stage III, 6 cases of stage IV and 1 case of stage V. 48 cases were completely relieved, accounting for 92.3%. There are 45 tumor-free patients, accounting for 86.5% of the patients in this group, with a duration of 3-72 months and a median of 13 months. CONCLUSIONS: It is feasible to carry out multi-center collaborative clinical research on Chinese children’s tumors. By this method, cases can be quickly accumulated, the treatment is more rational, and the overall diagnosis and treatment of children’s tumors in China is improved. The diagnosis and treatment programs adopted in this group are effective and safe .