4期神经母细胞瘤伴有骨髓转移的治疗疗效及预后分析  

Study on the chemotherapy efficacy and prognosis of neuroblastoma of stage 4 with bone marrow metastasis

作　　者：张谊[1] 张伟令[1] 黄东生[1] 王一卓[1] 洪亮[1] 易优[1] 胡慧敏[1] 李静[1] 韩涛[1] 周燕[1] 李凡[1] ZHANG Yi;ZHANG Welling;HUANG Dongsheng;WANG Yizhuo;HONG Liang;YI You;HU Humin;LI ring;HAN Tao;ZHOU Yan;LI Fan(Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China)

机构地区：[1]首都医科大学附属北京同仁医院儿科,北京100176

出　　处：《中国小儿血液与肿瘤杂志》2018年第2期69-73,共5页Journal of China Pediatric Blood and Cancer

摘　　要：目的骨髓转移是影响神经母细胞瘤(NB)预后的最主要的危险因素之一,本文旨在研究伴有骨髓转移的4期NB的临床特点、近期疗效与预后分析。方法根据COG分期标准,收集2006年2月-2016年1月间确诊的4期NB同时伴有骨髓转移患儿的临床资料。分析发病特点、疗效、危险因素与预后的相关性。Kaplan-Merier曲线进行生存分析。结果 (1)临床资料:106例患儿中,男73例(68.9%),女33例(31.1%),男:女=2.21:1。中位年龄42个月,≤18个月患儿19例,占17.9%,>18个月患儿87例(82.1%)。(2)临床疗效:诱导化疗后完全缓解(CR)63例,占59.4%;部分缓解(PR)28例,占26.4%;进展12例,占11.3%;进展后放弃治疗3例,占2.8%。(3)随访及预后:随访至2016年3月31日,中位随访时间28个月。106例患儿死亡37例,存活68例,失访1例,总生存率为64.7%(68/105)。中位生存时间36个月。随访过程中复发至少1次的病例为59例,占55.7%(59/106)。59例复发患儿死亡30例,生存28例,失访1例,总生存率48.3%(28/58)。非参数分析提示,年龄、疗效及是否存在复发均与预后相关(P值分别为0.041,0.050,0.008)。结论骨髓转移是导致NB预后不良的重要因素,化疗可缓解骨髓转移,但如何控制骨髓转移及预防骨髓复发仍是临床面临的主要问题。Objective Bone Marrow metastasis （BMM） is one of the most important prognosis factors for patients with neuroblastoma. Our aim is to study the clinical characters, efficacy and prognosis of stage 4 NB with BMM. Methods According to COG stage criteria, we collected stage 4 NB patients with BMM from Feburary 2006 to January 2016, and analyzed the relationship among disease characters, efficacy, risk factors and prognosis. Survival analysis was performed by Kaplan-Merier curve. Results （1） clinical data： of the 106 patients, 73 were male （68.9%）, and 33 were female （31.1%）. The ratio of male to female was 2.21 ： 1. The median age was 42 months, 19 patients （17.9%） were ~〈18 months and 87 cases （82. 1% ） were 〉 18 months. （2） clinical efficacy complete remission （CR） after induction chemotherapy; 28 patients （26 （PR） ; 12 patients （2.8%） suffered disease progress, accounting for 11 63 patients （59. 4% ） received 4% ） received partial remission 3 % ; and 3 patients abandoned because of disease progress. （5） follow-up and prognosis： followed up to March 31, 2016, the median time was 28 months. Among the 106 children, 37 died, 68 survived and only one lost follow up. Tile overall survival （OS） was 64.7% （68/105）. The median survival time was 36 months. Fifty-nine （55.7%） patients had relapse at least one time during follow-up, of which 30 cases died, 28 survived, and one lost follow-up. The OS of the 59 relapsed patients was 48.3% （28/58）. There were significant different from age, relapse, efficacy to survival （ P = O. 041, 0. 050, 0. 008 ） , according to nonparametric analysis. Conclusions BMM is an important factor for poor prognosis of NB and could be relieved by chemotherapy. However, how to control BMM and reduce relapse is still a main clinic problem.

关 键 词：神经母细胞瘤 化疗 复发 骨髓转移 预后 

分 类 号：R739.4[医药卫生—肿瘤]