Practice status and influencing factors of adrenalectomy in patients with Wilms tumor

作者全名："Jiang, Hong-Fei; Tian, Xiao-Mao; Ma, Wei; Shi, Qin-Lin; Lu, Peng; Liu, Feng; Liu, Xing; He, Da-Wei; Lin, Tao; Wei, Guang-Hui"

作者地址："[Jiang, Hong-Fei; Tian, Xiao-Mao; Ma, Wei; Shi, Qin-Lin; Lu, Peng; Liu, Feng; Liu, Xing; He, Da-Wei; Lin, Tao; Wei, Guang-Hui] Children Hosp Chongqing Med Univ, Dept Urol, Chongqing, Peoples R China; [Jiang, Hong-Fei; Tian, Xiao-Mao; Ma, Wei; Shi, Qin-Lin; Lu, Peng; Liu, Feng; Liu, Xing; He, Da-Wei; Lin, Tao; Wei, Guang-Hui] Childrens Hosp Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Minist Educ Key Lab Child Dev & Disorders, Chongqing Key Lab Pediat, Chongqing, Peoples R China; [Jiang, Hong-Fei; Tian, Xiao-Mao; Shi, Qin-Lin; Liu, Feng; Liu, Xing; He, Da-Wei; Wei, Guang-Hui] Chongqing Key Lab Children Urogenital Dev & Tissue, Chongqing, Peoples R China; [Shi, Qin-Lin] Children Hosp Chongqing Med Univ, Dept Urol, Chongqing, Peoples R China"

通信作者："Shi, QL (通讯作者)，Children Hosp Chongqing Med Univ, Dept Urol, Chongqing, Peoples R China."

来源：ASIAN JOURNAL OF SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000898075500008

JCR分区：Q1

影响因子：3.5

年份：2023

卷号：46

期号：1

开始页：52

结束页：57

文献类型：Review

关键词：Wilms tumor; Adrenal; Adrenalectomy; Adrenal invasion; Risk factors

摘要："To investigate the clinical practice status and factors that influence adrenalectomy along with the impact on prognosis in patients with Wilms Tumor (WT). We retrospectively reviewed the demographic, clinical, and follow-up data of patients with WT, including age, tumor side, tumor volume, tumor location within the kidney, stage, pathological type, tumor rupture, levels of adrenocorticotropin (ACTH), renin, aldo-sterone, and adrenal management, as well as outcomes. The primary outcomes are adrenal practice status and 5-year relapse-free survival (RFS). A total of 162 patients were enrolled in this study. Of these, 131 patients underwent radical nephrectomy with adrenalectomy, and adrenal invasion was only noted in three patients (2.3%). Adrenalectomy was associated with tumor volume and clinical stage (P < 0.05). Multivariable logistic regression analysis (OR = 3.982, P = 0.005) and ROC curve analysis (AUC = 0.708, P = 0.0003) revealed that a larger tumor volume independently increased the risk of adrenalectomy. Adrenalectomy was not significantly associated with tumor location, tumor rupture, or local recurrence (P > 0.05). In addition, the study median follow-up was 50.95 months. The 5-year RFS rates of patients with removed adrenal gland and preserved adrenal gland were 90.3% and 75.8%, respectively (P = 0.078). We followed up children more than 3 years after removal of the adrenal glands, and no children with reduced ACTH, aldosterone, or renin were found. Multivariate Cox regression analysis showed no sig-nificant difference on prognosis (P = 0.203), even after adjusting for clinical stage and pathological type. Finally, no evidence of adrenal insufficiency was reported during the follow-up examinations. Our data indicated that invasion of the ipsilateral adrenal gland is rare in WT. Preserving the ipsilateral adrenal gland was not associated with prognosis. Preoperative adequate assessment tumor volume and intra-operative detection of adrenal invasion were necessary to determine whether or not to perform an adrenal resection.(c) 2022 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/)."

基金机构：National Key Clinical Specialty Discipline Construction Program of China; Natural Science Foundation of Chongqing Province of China; [2013 (544)]; [cstc2021jcyj-msxmX0549]

基金资助正文："Funding The patients? enrollment and data curation was supported by the National Key Clinical Specialty Discipline Construction Program of China, No. 2013 (544) . Natural Science Foundation of Chongqing Province of China (cstc2021jcyj-msxmX0549)"