不同组合化疗方案治疗肝母细胞瘤的疗效比较  

Outcome of chemotherapy regimens of different combinations for hepatoblastoma

作　　者：苏港林 刘红艳[2] 孙岩峰[2] 苗丽霞[2] 王军[2] 李彦珊[2] 袁海莲[2] 刘秋玲[1,2] 

机构地区：[1]安徽医科大学研究生学院,合肥230032 [2]武警总医院儿科,北京100039

出　　处：《武警医学》2016年第10期1012-1017,共6页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的比较不同化疗方案治疗肝母细胞瘤（hepatoblastoma,HB）的临床疗效。方法分析并总结我院2007-08至2016-02收治的23例HB患儿资料,比较不同治疗方案的疗效,其中2007-08至2013-03的12例为A组,2013-03至2016-02的11例为B组。两组均采用化疗联合手术治疗方案。采用美国儿童肿瘤协会（COG）临床分期将肿瘤分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期;可早期切除肿瘤者先行手术,其余病例给予术前化疗1~3周期后再行影像学检查评估切除可能性。A组Ⅰ、Ⅱ、Ⅲ期的化疗方案为长春新碱＋表阿霉素＋环磷酰胺,Ⅳ期为顺铂＋表阿霉素;B组Ⅰ、Ⅱ期的化疗方案为顺铂＋长春新碱＋氟尿嘧啶,Ⅲ、Ⅳ期为顺铂＋表阿霉素。对两组资料总体及各分期两两进行疗效比较。结果 23例患儿均完整切除肿瘤。截止至随访时间（2016-02-01）,A、B两组患儿无进展生存时间达1年的例数分别为5和10,其1年无进展生存率分别为41.7%和90.9%。B组1年无进展生存率高于A组（P=0.023）。A、B两组患儿总生存时间达1年的例数分别为7和10,其1年总生存率分别为58.3%和90.9%。B组1年总生存率高于A组（P=0.040）,差异有统计学意义。两组资料中相同分期资料进行两两疗效比较,其结果差异无统计学意义。两组患儿均有不同程度的化疗后骨髓抑制及脏器有不良反应。结论顺铂＋表阿霉素/顺铂＋长春新碱＋氟尿嘧啶较长春新碱＋表阿霉素＋环磷酰胺治疗HB疗效较好。两组资料中分期两两比较后,与长春新碱＋表阿霉素＋环磷酰胺方案相比,顺铂＋表阿霉素/顺铂＋长春新碱＋氟尿嘧啶治疗HB的疗效无明显差异;可能由于此组资料中病例数较少原因所致,但仍需进一步验证。Objective To study the clinical effect of different chemotherapy regimens for children with hepatoblastoma.Methods Clinical data of 23 cases with hepatoblstoma who had been treated in our hospital between August 2007 and February 2016 were summarized. Different chemotherapy regimens were used before and after March 2013. Patients were divided into Group A（ 12 patients treated between August 2007 and March 2013） and Group B（ 11 patients treated between March 2013 and February 2016）.Chemotherapy combined with surgical treatment was used in both groups. According to the COG stage,patients were stratified into stageⅠ,Ⅱ,Ⅲ,Ⅳ. If feasible,partial hepatectomy（ primary or delayed surgery） was then performed,and four to six final courses were given after AFP was decreased to the normal value. Patients with stage Ⅰ,Ⅱ,Ⅲ in Group A were treated with vincristine,epirubicin and cyclophosphamide while those withstage Ⅳ were treated with cisplatin and epirubicin. In Group B,patients with stage Ⅰ,Ⅱwere treated with cisplatin,vincristine and fluorouracil,and those with stage Ⅲ,Ⅳ treated with cisplatin and epirubicin.Results Complete resection was achieved in each case of hepatoblastoma. By the cutoff date（ February 1,2016）,Group B（ 90. 9%） had a higher 1-year PFS rate than group A（ 41. 7%）（ P = 0. 23）. Also,group B（ 90. 9%） had a higher 1-year OS rate than group A（ 58. 30%）（ P = 0. 40）. Patients in both groups had different degrees of bone marrow suppression after chemotherapy.Conclusion Cisplatin,epirubicin / cisplatin,vincristine and fluorouracil are more effective than vincristine,epirubicin,and cyclophosphamide for children with hepatoblastoma. There is no difference between these chemotherapy regimens,which may be due to the limited amount of data. The side effects of PLA and EPI,and PLA,VCR and 5-FU are reversible and tolerable.

关 键 词：肝母细胞瘤 化疗 顺铂 甲胎蛋白 

分 类 号：R735.7[医药卫生—肿瘤]