术前化疗对进展期神经母细胞瘤儿童手术切除率及预后的影响  

Effect of Preoperative Chemotherapy on Resection Rate and Prognosis of Advanced Neuroblastoma in Children

作　　者：李作青[1] 李穗生[1] 刘钧澄[1] 刘唐彬[1] 谢勇[1] 类成勇[1] 邓高燕[1] 

机构地区：[1]中山大学附属第一医院小儿外科,广州510080

出　　处：《实用儿科临床杂志》2008年第17期1379-1381,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨术前化疗对进展期神经母细胞瘤(NB)患儿手术切除率及预后的影响。方法收集2000年1月-2006年12月本院收治的采取手术治疗的进展期(Ⅲ、Ⅳ期)NB患儿55例,均经病理确诊。男31例(56.4%),女24例(43.6%);年龄54.1(4～147)个月。根据国际NB分期标准(INSS),本组病例Ⅲ期27例(49.1%),Ⅳ期28例(50.9%)。55例患儿均行手术治疗,其中45例患儿采取术前化疗,平均化疗5.3(1～14)个疗程,10例未采取术前化疗。结果随访44例,随访率为80%。生存18例,总体生存率为40.9%。化疗前肿瘤体积[B超:(524.9±480.7)cm3,CT:(339.3±289.4)cm3];手术前肿瘤体积[B超:(195.9±309.8)cm3,CT:(75.4±73.0)cm3],二者比较均有统计学差异(Pa<0.05);瘤体缩减率为(63.68±24.99)%。术前化疗组肿瘤切除率(包括完全切除和大部分切除)为88.9%,术前未化疗组肿瘤切除率为50%,2组比较有统计学差异(P<0.05)。肿瘤切除者(包括完全和大部分切除)1a生存率为78.9%,2a生存率为63.9%;肿瘤未切除者(包括部分切除和探查活检)1a生存率为37.5%,2a生存率为18.8%,2组比较有统计学差异(Pa<0.05)。结论术前化疗可以提高进展期NB患儿的手术切除率,进而改善预后。Objective To investigate the impact of preoperative chemotherapy on resection rate and prognosis of advanced neuroblastoma （NB） in children. Methods Fifty - five children with advanced NB were treated in our hospital between Jan. 2000 and Dec. 2006, and all diagnosis were confirmed by pathology. Thirty - one were male（56.4% ） and 24 were female（43.6% ） ;mean age at the initial admission was 54.1 months（ ranging from 4 to 147 months）. According to the international NB staging system （INSS） ,27 cases （49.1% ）were classified at stage Ⅲ and 28 cases（50.9% ） at stage Ⅳ. All children in this study underwent surgery, among them 45 cases were given preoperative chemotherapy,the mean time was 5.3 courses（ ranging from 1 to 14 courses）, 10 cases were not given preoperative chemotherapy. Results Follow - up was available for 44 cases （80%）, and 18 cases were still alive, The overall survival rate was 40.9%. The tumor volume before chemotherapy was Type - B ultrasonic ： （ 524.9 ± 480.7 ） cm^3, CT ： （ 339.3 ± 289.4 ） cm^3, and the tumor volume before operation was Type - B ultra- sonic ： （ 195.9 ± 309.8 ） cm^3 , CT ： （ 75.4 ± 73.0 ） cm^3 , the difference was statistically significant between 2 groups （ Pa 〈 0.05 ）. The rate of tumor reduction was （ 63.68 ± 24.99 ） %. The resection rate （ including total and subtotal excision ） in preoperative chemotherapy group （88.9%） was statistically superior to that of the non - preoperative chemotherapy group（50% ） （P 〈 0.05 ）. The 1 - year and 2 - year survival rate in patients with tumor resection（ including total and subtotal excision） was 78.9% and 63.9% ,respectively;while the 1 - year and 2 -year survival rate in children without tumor resection （including differences between the 2 groups were statistically significant （ Pa 〈 0. 05 ）. Conclusion Preoperative chemotherapy can increase the resectability and improve the prognosis of children with advanced NB.

关 键 词：神经母细胞瘤 进展期 术前化疗 手术切除率 预后 儿童 

分 类 号：R739.4[医药卫生—肿瘤]