48例肝母细胞瘤儿童肺部转移瘤切除术后的预后分析  

Prognostic analysis of 48 children with hepatoblastoma after pulmonary metastasectomy

作　　者：胡慧敏[1] 张伟令[1] 黄东生[1] 王一卓[1] 张谊[1] 李静[1] Hu Huimin;Zhang Weiling;Huang Dongsheng;Wang Yizhuo;Zhang Yi;Li Jing(Department of Pediatrics,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院儿科,100176

出　　处：《国际儿科学杂志》2020年第9期658-663,共6页International Journal of Pediatrics

基　　金：北京市医管局"登峰"人才培养计划(DFL20180201)。

摘　　要：目的:总结分析行肺部转移瘤切除术的肝母细胞瘤(hepatoblastoma,HB)患儿的预后特点。方法:收集2009年1月1日至2017年12月31日在我院住院治疗的48例行肺部转移瘤切除术HB患儿的临床资料,应用统计学方法分析行肺转移瘤切除术HB患儿的预后。结果:48例均诊断HB伴有肺转移,其中单独伴有肺转移者30例,肺转移同时伴有其他影响预后高危因素者18例。48例均行肺部转移瘤切除术,43例肺部肿瘤完全切除,5例肿瘤部分切除。25例第1次肺部转移瘤切除术后出现复发(25/48,52.1%),2例疾病进展。患儿中位随访45.5个月,48例行肺部转移瘤切除术患儿的生存时间(83.59±7.01)个月,3年总生存率为58.0%。单纯肺转移组和肺转移同时伴有其他高危因素组的生存时间和3年总生存率比较,有统计学意义[(95.89±8.19)个月比(58.95±9.40)个月;79.4%比50.0%;χ^2=4.849,P=0.028)]。肺部转移瘤切除术后有复发或进展组及无复发或进展组的生存时间及3年总生存率比较,有统计学意义[(56.84±7.22)个月比(112.48±7.08)个月;55.6%比90.5%;χ^2=11.03,P=0.001)]。COX回归分析显示,肺转移同时伴有其他高危因素的HB患儿发生死亡的风险是仅伴有肺转移患儿的3.424倍(RR=3.424,95%CI:1.264-9.275)。结论:肺部转移瘤切除术后患儿的总体预后不良,术后复发比例高;肺部转移同时伴有其他高危因素是影响肺部肿瘤切除术HB组患儿预后的主要危险因素。Objective To summarize the prognostic characteristics of hepatoblastoma in children undergoing pulmonary metastasectomy.Methods The clinical data of 48 hepatoblastoma patients with pulmonary metastases who underwent pulmonary metastases resection in our hospital from January 12009 to December 31,2017 were collected,and prognosis of these patients was analyzed.Results Forty eight cases were diagnosed as hepatoblastoma with pulmonary metastasis,including 30 cases with pulmonary metastasis alone and 18 cases accompany with other high risk factors affecting prognosis.All the 48 patients underwent pulmonary metastasectomy,in which 43 patients were given pulmonary metastases resection completely and 5 patients were given partial resection of metastases.Twenty-five cases recurred after the first pulmonary metastasis resection(25/48,52.1%),and 2 cases progressed.With the median follow-up time of 45.5 months,survival time of 48 patients with pulmonary metastasectomy was(83.59±7.01)months,and the 3-year overall survival rate was 58%.Of the groups those were patients with pulmonary metastasis alone and patients with other high risk factors affecting prognosis,the survival time and the 3-year overall survival rate showed a significant statistical differences[(95.89±8.19)months vs.(58.95±9.40)months;79.4%vs.50%;χ^2=4.849,P=0.028)].The survival time and 3-year survival rate of the two groups between with recurrence or progression and the group without recurrence or progression after pulmonary metastases resection were showed a significant difference[(56.84±7.22)months vs.(112.48±7.08)months;55.6%vs.90.5%;χ^2=11.03,P=0.001)].Results of COX regression analysis showed that the main risk factor affecting prognosis was pulmonary metastasis accompany with other high-risk factors for hepatoblastoma patients.The death risk of patients with pulmonary metastasis accompany with other high-risk factors was 3.424 times than that of patients without other high-risk factors(RR=3.424,95%CI:1.264~9.275).Conclusion The overall prognosis

关 键 词：儿童 肝母细胞瘤 转移 转移瘤切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤]