월름종양의 장기 추적 관찰

Abstract

Purpose: With the use of combined-modality therapy, the survival of the patients with the Wilms tumor has been improved during past 30 years. We reviewed the clinical characteristics and treatment outcome of pediatric Wilms tumor patients diagnosed during recent 20 years' period and compared this data with previous reports. Methods: From June 1979 to April 2000, 61 patients were diagnosed with Wilms tumor. Retrospective analysis of the medical records of these patients was performed. Results: A male to female ratio was 1.2：1. Median age at diagnosis was 3 years 2 months. Initial symptoms at diagnosis were abdominal mass (85.3%), gross hematuria (9.8%) and abdominal pain (4.9%). The two major pathologic types of Wilms tumor were favorable (80.4%) and unfavorable (19.6%) histology. The number of patients by staging according to National Wilms Tumor Study (NWTS) Group was as follows: Stage I 27.8% (17/61), Stage II 23.0% (14/61), Stage III 26.2% (16/61), Stage IV 19.7% (12/61) and Stage V 3.3% (2/61). The incidence of recurrence in Wilms tumor has been reported to be about 18.0% (11/61). The most common sites of relapse are the lung and abdomen. Among 61 patients, 10-year overall survival rate was 70.6%. According to histology, 10-year overall survival rate was 80.2% in favorable group and 28.0% in unfavorable group. The 10-year overall survival rate of was 59.4% from 1979 to 1990 and 83.9% from 1991 to 2000. The 10-year survival rate from 1979 to 1990 by staging was as follows: Stage I 83.3%, Stage II 66.6%, Stage III 60.0% and Stage IV 44.4% The 10-year survival rate from 1991 to 2000 by staging was as follows: Stage I 100%, Stage II 83.3%, Stage III 100% and Stage IV 50.0%. Conclusion: The clinical characteristics, histology, relapse and treatment outcome was similar to those reported by NWTS. There has been marked improvement of survival in Wilms tumor over the past 20 years. Despite the remarkable success in the treatment of Wilms tumor, there are still as a small patients who will suffer a relapse.