肝母细胞瘤预后评分系统的建立并比较其与常见预后模型的预测价值  

Establishment of hepatoblastoma prognostic scoring system and its prognostic value comparison with other common prognostic models

作　　者：葛军涛[1] 李龙[2] 乔国梁[2] 魏延栋[2] 张震[2] 刘树立[2] 张军[2] 王琛[2] 于蒲[2] 

机构地区：[1]山东省千佛山医院儿外科,济南250013 [2]首都儿科研究所

出　　处：《中华小儿外科杂志》2015年第1期21-25,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金面上项目（81170335）

摘　　要：目的通过分析影响肝母细胞瘤预后的危险因素建立预后评分系统，并比较其与常见肝母细胞瘤的分期系统的预测价值。方法回顾性分析2001年至2012年经本院收治的136例肝母细胞瘤患儿临床和病理资料及随访到的112例患儿信息，治疗以手术加化疗为主，化疗分为术前化疗和术后化疗。通过Kaplan-Meier曲线和Log-Rank检验以及Cox比例风险回归模型筛选出来的预后危险因素建立我们的预后评分系统，采用ROC曲线下面积（AUC）比较其与PRETEXT分期系统、TNM分期系统、CCSG／POG分期系统对肝母细胞瘤患儿5年生存率的预测能力。结果112例患儿中男54例，女58例，中位随访时间35．6个月（3～144个月），中位生存期83．5个月。多因素危险因素分析得出AFP水平、肿瘤单发多发、PRETEXT分期、有无转移、血管侵犯是肝母细胞瘤患儿的独立危险因素，通过比较将我们的分期系统分成三层并且有统计学意义。根据R（X2曲线得出新建评分系统的曲线下面积（AUC）为0．785（95％CI：0．698～0．873），CCSG／POG分期：0．775（95％CI：0．688～0．862），TNM分期：0.682（95％CI：0．579～0．786），PRETEXT分期：0．665（95％CI：0．566～0.764）。结论新建预后评分系统对肝母细胞瘤患儿5年生存率的预测能力优于其他三个分期系统。Objective To analyze the prognostic factors of hepatoblastoma for establishing a prognostic scoring system and compare it with common hepatoblastoma staging systems. Methods Retrospective analyses of 2001-2012 were conducted for 136 children of hepatoblastoma. The clinicopathological data and follow-up profiles were recorded for 112 cases. The treatment protocol was composed of surgery plus pre- and post-operative chemotherapies. The Kaplan-Meier curves, Log-rank test and Cox proportional hazard regression model were used to determine the prognostic risk factors for our prognostic scoring system. And its predictive ability of 5-year survival rate was compared with those of PRETEXT, TNM and CCSG/POG staging systems. The area under the receiver operating characteristic （ROC） curve （AUC） was employed for forecasting the survival function. Results Among 112 children of hepatoblastoma, there were 54 boys and 58 girls with a median follow-up time of 35.6 （3-144） months and a median survival time of 83. 5 months. Multivariate analysis of risk factors showed alpha fetoprotein （AFP） level, single/multiple tumor, PRETEXT stage, metastasis and vascular invasion were independent risk factors. By comparison, our staging system was divided into 3 layers of statistical significance. The ROC curve showed the new staging system＇s AUC was 0. 785 （95% CI： 0. 698-0 . 873）, CCSG/POG staging： 0. 775 （95% CI： 0. 688-0. 862）, TNM staging： 0. 682 （95% CI： 0. 579-0. 786） and PRETEXT staging： 0. 665 （95% CI： 0. 566-0. 764）. Conclusions The new staging system for children with hepatoblastoma is superior to other three staging systems in predictive ability of 5-year survival rate.

关 键 词：肝母细胞瘤 危险因素 预后 

分 类 号：R735.7[医药卫生—肿瘤]