Background: Lymph node status is a prognostic factor in Wilms tumor, and adequate lymph node sampling is strongly recommended. This study investigates the impact of lymph node ratio (LNR) (number of positive to examined lymph nodes) on overall survival in children with resected Wilms tumors.Methods: This retrospective National Cancer Database analysis included children (<18 years) who underwent resection with lymph node sampling for unilateral, non-metastatic Wilms tumor.Results: Among 2206 patients, the median age was three years, the median tumor size was 10.5 cm, and the median number of examined nodes was five. A total of 82.1% of patients had an LNR of 0, 5.4% had an LNR < 0.2, and 12.5% had an LNR ≥ 0.2. In multivariable Cox regression, LNR ≥ 0.2 was associated with worse survival (HR = 1.75, 95%CI: 1.03–2.97,p= 0.04), along with increasing age (HR = 1.11, 95%CI: 1.05–1.17,p< 0.001) and tumor size (HR = 1.03, 95%CI: 1.00–1.06,p= 0.03).Conclusions: LNR is an independent prognostic factor in Wilms tumor and may refine risk stratification and guide treatment decisions.
背景：淋巴结状态是肾母细胞瘤的预后因素，强烈建议进行充分的淋巴结取样。本研究探讨淋巴结比率（阳性淋巴结数与检测淋巴结数之比）对接受切除手术的肾母细胞瘤患儿总生存期的影响。 方法：本回顾性研究基于国家癌症数据库，纳入了接受单侧、非转移性肾母细胞瘤切除手术并进行了淋巴结取样的儿童（<18岁）。 结果：在2206例患者中，中位年龄为3岁，中位肿瘤大小为10.5厘米，中位检测淋巴结数为5个。82.1%的患者淋巴结比率为0，5.4%的患者淋巴结比率<0.2，12.5%的患者淋巴结比率≥0.2。在多变量Cox回归分析中，淋巴结比率≥0.2与较差的生存率相关（风险比=1.75，95%置信区间：1.03–2.97，p=0.04），年龄增长（风险比=1.11，95%置信区间：1.05–1.17，p<0.001）和肿瘤大小增加（风险比=1.03，95%置信区间：1.00–1.06，p=0.03）也是不良预后因素。 结论：淋巴结比率是肾母细胞瘤的独立预后因素，可用于优化风险分层并指导治疗决策。
The Impact of Lymph Node Ratio for Children with Wilms Tumors: A National Cancer Database Analysis
肿瘤(癌症)患者之家