C5V作为首选化疗方案治疗肝母细胞瘤效果观察  

Outcome of hepatoblastoma： experience with 63 patients received chemotherapy with the regimen C5V

作　　者：柳龚堡[1] 刘百慧[1] 李凯[1] 董岿然[1] 肖现民[1] 

机构地区：[1]复旦大学附属儿科医院外科,上海201102

出　　处：《中华儿科杂志》2015年第2期119-123,共5页Chinese Journal of Pediatrics

摘　　要：目的 总结C5V方案（顺铂＋5-氟尿嘧啶＋长春新碱）治疗肝母细胞瘤的经验,并探讨影响治疗效果的相关因素.方法 回顾分析2006年1月至2014年4月在复旦大学附属儿科医院治疗的肝母细胞瘤病例资料,共63例采用C5V作为首选化疗方案,其中男37例,女26例,初诊年龄6d～ 124个月,中位年龄15个月.按照PRETEXT分期系统,其中Ⅰ期4例、Ⅱ期16例,Ⅲ期28例,Ⅳ期15例.其中有9例（Ⅰ期4例、Ⅱ期5例）行一期肿瘤切除术,剩余54例需术前辅助化疗.中位随访时间30个月.结果 40例患儿经辅助化疗后行延期肿瘤切除术,其中C5V方案单独化疗35例,C5V配合CITA方案（顺铂＋阿霉素）化疗5例,术前平均化疗时间为（3.4±1.7）个疗程.49例行肿瘤切除术患儿术后平均化疗（5.3±2.0）个疗程.术后复发12例（24.5％）,切缘＜0.5 cm、静脉瘤栓、Ⅲ或Ⅳ期肿瘤是术后复发的危险因素（P =0.049、0.001、0.022）.本组病例2年和5年总体生存率分别为61.1％、58.7％,其中Ⅰ～Ⅲ期分别为75.0％和75.0％,100.0％和100.0％、65.8％和61.4％.Ⅳ期的1年和3年的总体生存率为20.0％和13.3％.单因素分析结果显示,初诊年龄＜60个月、静脉瘤栓、初诊时伴有血小板增多症、Ⅲ或Ⅳ期肿瘤、肿瘤完整切除是生存时间的影响因素（P=0.019、＜0.001、0.011、0.001、＜0.001）.多因素分析提示肿瘤完整切除（P＜0.001）,初诊年龄＜ 60个月（P =0.004）是重要的影响因素.结论 C5V是肝母细胞瘤有效的治疗方案,肿瘤完整切除仍是治疗的关键.生存时间的影响因素包括年龄、分期、伴随症状等.Objective To summarize the experience of the chemotherapy regimen cisplatin ＋ fluorouracil ＋ vincristine （C5V） for hepatoblastoma,and analyze the factors associated the outcome.Method A retrospective analysis was conducted for the outcome of hepatoblastoma.Sixty-three patients who received the regimen of C5V as the first choice of chemotherapy were reviewed,including 37 males and 26 females.The age at diagnosis ranged from 2 days after birth to 124 months,median 15 months.Four patients with stage Ⅰ,16 patients with stage Ⅱ,28 patients with stage Ⅲ,15 patients with stage Ⅳ disease were enrolled in the study.Nine patients had primary tumor resection while the remain by 54 received neoadjuvant chemotherapy.The median follow-up time was 30 months.Result Forty patients had delayed surgery,including 35 patients with regimen C5V alone,the others were treated with regimen C5V and cisplatin ＋ adriamycin （CITA）.The mean time of neojuvant chemotherapy was （3.4-1.7） cycles.The mean time of chemotherapy after surgery was （5.3 ±2.0） cycles.In 12 cases the （24.5%） tumor recurred after surgery.The margin of resection less than 0.5 cm,vascular invasion,stage Ⅲ or Ⅳ disease were all the high risks of relapse （P =0.049,0.001,0.022,respectively）.Two-year overall survival （OS） and 5-year OS of the study was 61.1% and 58.7%,respectively.The 2-year OS and 5-year OS of stage Ⅰ to Ⅲ were 75.0% and 75.0%,100.0% and 100.0%,65.8% and 61.4%.The 1-year OS and 3-year OS of stage Ⅳ was 20.0%,13.3%,respectively.Univariate analysis showed that age at diagnosis less than 60 months,vascular invasion,thrombocythemia at diagnosis,stage Ⅲ or Ⅳ,tumor resection was the prognostic factor （P =0.019,〈 0.001,0.011,〈 0.001,respectively）.Multivariate analysis showed that tumor resection and age at diagnosis less than 60 months were both the prognostic factor （P 〈 0.001,0.004,respectively）.Conclusion The regimen of C5V is useful for hepatoblastoma.Tumor resection is the key factor of treatm

关 键 词：抗肿瘤联合化疗方案 治疗结果 肝母细胞瘤 

分 类 号：R735.7[医药卫生—肿瘤]