肾母细胞瘤(Wilms tumor,WT)是儿童最常见的肾恶性肿瘤。COG(Children’s Oncology Group,儿童肿瘤协作组)和SIOP(International Society of Paediatric Oncology,国际儿童肿瘤学会)两大儿童肿瘤研究的国际协作组织分别形成了各自的诊...肾母细胞瘤(Wilms tumor,WT)是儿童最常见的肾恶性肿瘤。COG(Children’s Oncology Group,儿童肿瘤协作组)和SIOP(International Society of Paediatric Oncology,国际儿童肿瘤学会)两大儿童肿瘤研究的国际协作组织分别形成了各自的诊疗方案:COG推荐手术优先,然后行化疗与放射治疗等辅助治疗;SIOP强调术前化疗,然后行手术与放射治疗。目前该两大协作组发布的肾母细胞瘤患者总体生存率均达到90%。中国抗癌协会小儿肿瘤专业委员会及中华医学会小儿外科学分会泌尿外科学组在COG和SIOP方案的基础上也先后发表了诊疗建议和共识。本文重点介绍COG方案和SIOP方案的异同,主要包括组织学分类、临床分期、危险度分组、治疗方案以及复发后治疗等方面;进而解读中国儿童肾母细胞瘤诊疗共识,分析中国的诊疗现状,供广大临床医师参考和借鉴。展开更多
Background Angiogenesis and lymphogenesis which were promoted by vascular endothelial growth factor （VEGF） and VEGF-C are important in the growth and metastasis of solid tumors. The high level of VEGF and VEGF-C wer...Background Angiogenesis and lymphogenesis which were promoted by vascular endothelial growth factor （VEGF） and VEGF-C are important in the growth and metastasis of solid tumors. The high level of VEGF and VEGF-C were distributed in numerous types of cancers, but their distribution and expression in Wilms tumor, the most common pediatric tumor of the kidney, was unclear. Methods To learn about the distribution, mass spectroscopy and immunohistochemistry were used to measure the level of VEGF and VEGF-C in serum and tissue of Wilms tumor. Results The expression level of VEGF in serum of Wilms tumor was the same as in pre-surgery and control, so it was the same case of VEGF-C. Both of these factors were chiefly located in Wilms tumor tissue, but not in borderline and normal. In addition, the higher clinical staging and histopathologic grading were important elements in high expression of VEGF and VEGF-C. Gender, age and the size of tumor have not certainly been implicated in expression level of VEGF and VEGF-C. Conclusions The lymph node metastasis and growth of tumors resulted from angiogenesis and lymphogenesis which were promoted by VEGF and VEGF-C in Wilms tumor. The autocrine and paracrine process of VEGF and VEGF-C were the principal contributor to specific tissues of Wilms tumor but not to the entire body.展开更多
Background Wilms＇ tumor （nephroblastoma） is the most common pediatric kidney cancer. Only one Wilms＇ tumor gene is known, WT1 at 11p13, which is mutated in 5%-10% of Wilms＇ tumors. Recently, mutations were report...Background Wilms＇ tumor （nephroblastoma） is the most common pediatric kidney cancer. Only one Wilms＇ tumor gene is known, WT1 at 11p13, which is mutated in 5%-10% of Wilms＇ tumors. Recently, mutations were reported in WTX at Xq11.1 in Wilms＇ tumors. This study investigated the mutation proportion, type, and distribution in WTX and WT1 in children with Wilms＇ tumor. The role of WTX/WT1 in the development of Wilms＇ tumor, and the relationship between clinical phenotype and genotype, were also studied. Methods Wilms＇ tumor specimens （blood samples from 70 patients and tumor tissue samples from 52 patients） were used. A long fragment of WTXand 10 exons and intron sequences of WT1 were amplified by polymerase chain reaction （PCR） from extracted genomic DNA and sequenced. A chi-square test compared the difference between the W-/-X mutation group and the no mutation group. The relationship between the mutations and clinical phenotype was analyzed. Results W7X mutations were found in 5/52 tumor tissues and in 2/70 peripheral blood samples （five cases in total, all point mutations）. Two patients had a WTX mutation in both samples. WT1 mutations were found in 2/52 tumor tissues and in 4/70 peripheral blood samples （five cases in total, all point mutations）. One patient had a WT1 mutation in both samples. Ten cases had WTX or WT1 mutation （19.2% of Wilms＇ tumors）. No overlapping WTX and WTI mutations were found. No significant differences in clinical parameters were found between patients with and without a W7X mutation. Conclusions WTX mutations occur early in Wilms＇ tumor development, but at a low proportion. There was no evidence that WTX is the main cause of Wilms＇ tumor. Clinical parameters of patients with WTX mutations are not related to the mutation, indicating a limited impact of WTX on tumor progression. WTX and WT1 mutations occur independently, suggesting a relationship between their gene products.展开更多
文摘肾母细胞瘤(Wilms tumor,WT)是儿童最常见的肾恶性肿瘤。COG(Children’s Oncology Group,儿童肿瘤协作组)和SIOP(International Society of Paediatric Oncology,国际儿童肿瘤学会)两大儿童肿瘤研究的国际协作组织分别形成了各自的诊疗方案:COG推荐手术优先,然后行化疗与放射治疗等辅助治疗;SIOP强调术前化疗,然后行手术与放射治疗。目前该两大协作组发布的肾母细胞瘤患者总体生存率均达到90%。中国抗癌协会小儿肿瘤专业委员会及中华医学会小儿外科学分会泌尿外科学组在COG和SIOP方案的基础上也先后发表了诊疗建议和共识。本文重点介绍COG方案和SIOP方案的异同,主要包括组织学分类、临床分期、危险度分组、治疗方案以及复发后治疗等方面;进而解读中国儿童肾母细胞瘤诊疗共识,分析中国的诊疗现状,供广大临床医师参考和借鉴。
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81071782）.
文摘Background Angiogenesis and lymphogenesis which were promoted by vascular endothelial growth factor （VEGF） and VEGF-C are important in the growth and metastasis of solid tumors. The high level of VEGF and VEGF-C were distributed in numerous types of cancers, but their distribution and expression in Wilms tumor, the most common pediatric tumor of the kidney, was unclear. Methods To learn about the distribution, mass spectroscopy and immunohistochemistry were used to measure the level of VEGF and VEGF-C in serum and tissue of Wilms tumor. Results The expression level of VEGF in serum of Wilms tumor was the same as in pre-surgery and control, so it was the same case of VEGF-C. Both of these factors were chiefly located in Wilms tumor tissue, but not in borderline and normal. In addition, the higher clinical staging and histopathologic grading were important elements in high expression of VEGF and VEGF-C. Gender, age and the size of tumor have not certainly been implicated in expression level of VEGF and VEGF-C. Conclusions The lymph node metastasis and growth of tumors resulted from angiogenesis and lymphogenesis which were promoted by VEGF and VEGF-C in Wilms tumor. The autocrine and paracrine process of VEGF and VEGF-C were the principal contributor to specific tissues of Wilms tumor but not to the entire body.
文摘Background Wilms＇ tumor （nephroblastoma） is the most common pediatric kidney cancer. Only one Wilms＇ tumor gene is known, WT1 at 11p13, which is mutated in 5%-10% of Wilms＇ tumors. Recently, mutations were reported in WTX at Xq11.1 in Wilms＇ tumors. This study investigated the mutation proportion, type, and distribution in WTX and WT1 in children with Wilms＇ tumor. The role of WTX/WT1 in the development of Wilms＇ tumor, and the relationship between clinical phenotype and genotype, were also studied. Methods Wilms＇ tumor specimens （blood samples from 70 patients and tumor tissue samples from 52 patients） were used. A long fragment of WTXand 10 exons and intron sequences of WT1 were amplified by polymerase chain reaction （PCR） from extracted genomic DNA and sequenced. A chi-square test compared the difference between the W-/-X mutation group and the no mutation group. The relationship between the mutations and clinical phenotype was analyzed. Results W7X mutations were found in 5/52 tumor tissues and in 2/70 peripheral blood samples （five cases in total, all point mutations）. Two patients had a WTX mutation in both samples. WT1 mutations were found in 2/52 tumor tissues and in 4/70 peripheral blood samples （five cases in total, all point mutations）. One patient had a WT1 mutation in both samples. Ten cases had WTX or WT1 mutation （19.2% of Wilms＇ tumors）. No overlapping WTX and WTI mutations were found. No significant differences in clinical parameters were found between patients with and without a W7X mutation. Conclusions WTX mutations occur early in Wilms＇ tumor development, but at a low proportion. There was no evidence that WTX is the main cause of Wilms＇ tumor. Clinical parameters of patients with WTX mutations are not related to the mutation, indicating a limited impact of WTX on tumor progression. WTX and WT1 mutations occur independently, suggesting a relationship between their gene products.
