PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析  

Application of PRETEXT staging system in evaluating treatment response of children with hepatoblastoma

作　　者：张财源[1] 李金凝 刘欢欢[1] 汪登斌[1] Zhang Caiyuan;Li Jinning;Liu Huanhuan;WANG Dengbin(Department of Radiology,Xinhua Hospital,Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院放射科,上海市200092

出　　处：《实用肝脏病杂志》2018年第4期505-508,共4页Journal of Practical Hepatology

基　　金：科技部国家重点研发计划项目(编号:2017YFC0109003)

摘　　要：目的探讨儿童肝母细胞瘤(HB)PRETEXT分期系统和CT征象在疗效评估中的应用价值。方法2013年1月~2016年8月经组织病理学检查确诊的47例HB患儿,回顾性分析其CT检查资料,以术后组织病理学检查结果为参照,分析术前PRETEXT分期系统的正确性,并分析不同病理学分型患儿肿瘤边界、形态、出血、钙化和囊变坏死程度等CT征象的异同。结果本组单纯上皮型30例(63.8%),上皮与间叶混合型17例(36.2%);8例直接手术患儿术前PRETEXT分期6例为II期,2例为III期,均与术后病理学诊断分期相符,39例化疗后手术患儿术前和术后PRETEXT分期准确率为79.5%(31/39);在47例患儿中,术前PRETEXTCT分期与术后病理学判定比,其准确率达83.0%(39/47);钙化多见于上皮与间叶混合型,本组病例中MDCT显示10例出现钙化,其中上皮与间叶混合型者8例,显著多于单纯上皮型(x2=8.313,P=0.004)。结论 PRETEXT术前和术后分期诊断HB患儿的准确率较高,结合特征性CT征象可提示组织病理学分型,为HB临床决策提供较为可靠的依据。Objective To evaluate the value of PRETEXT staging system and CT imaging features in evaluating treatment response of pediatric hepatoblastoma(HB).Methods The multi-detector CT imaging features in 47 children with pathologically confirmed HB were retrospectively reviewed between January 2013 and August 2016.The consistency between PRETEXT stage and post-surgical pathological grade was assessed.The CT imaging findings,including tumor margin,morphology,intra-tumor hemorrhage,calcification and intra-tumor cystic necrosis,and pathological grades was evaluated.Results Out of 47 children with HB,30(63.8%)were pathological-proven epithelial,and 17(36.2%)with epithelial-mesenchymal type;eight children with HB,including 6 with PRETEXT stage II and 2 with PRETEXT stage III,received surgery without chemotherapy,and their PRETEXT stages was completely consistent with pathological-proven grade,and the accuracy rate between POSTTEXT stages and pathological grades reached 79.5%(31/39)in 39 children receiving surgery after chemotherapy;the overall accuracy of PRETEXT stage was 83.0%as compared with post-surgical pathological grade;out of ten children with tumor calcification,eight was with epithelial-mesenchymal type tumor,much higher than in with epithelial type(x2=8.313,P=0.004).Conclusion The PRETEXT stage is well consistent with post-surgical grade,and it might predict the pathological grade in consideration of specific image findings,which is helpful in determining management strategy of children with HB.

关 键 词：肝母细胞瘤 儿童 PRETEXT分期 计算机X线体层摄影术 

分 类 号：R730.44[医药卫生—肿瘤] R735.7[医药卫生—临床医学]