BEP方案治疗儿童阴道内胚窦瘤的效果分析  

Analysis of curative effect of BEP chemotherapy in endodermal sinus tumor of vagina.

作　　者：韩建宇 常晓峰[1] 秦红[1] 杨维[1] 韩炜[1] 成海燕[1] 何乐健[2] 王焕民[1] Han Jianyu;Chang Xiaofeng;Qin Hong;Yang Wei;Han Wei;Cheng Haiyan;He Lejian;Wang Huanmin(Department of Pediatric Oncological Surgery;Department of Pathology,National Center for Children's Health,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China.)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院肿瘤外科,北京市100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院病理科,北京市100045

出　　处：《临床小儿外科杂志》2021年第6期557-561,575,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的探究BEP方案治疗儿童阴道内胚窦瘤的效果及预后。方法回顾性分析2008—2020年首都医科大学附属北京儿童医院收治的12例阴道内胚窦瘤患者的临床资料。所有患者治疗前经病理确诊。收集患者临床表现、发病年龄、肿瘤大小及有无远处转移等资料。随访内容包括超声检查、CT检查和血清甲胎蛋白(alpha fectoprotein,AFP)水平。化疗方案采用国际标准BEP三联化疗方案:博莱霉素、依托泊苷和顺铂。预后评价采用世界卫生组织通用实体瘤疗效评价标准,分为完全缓解(complete response,CR)、部分缓解(partial response,PR)、疾病稳定(stable disease,SD)和疾病进展(progressive disease,PD)4个等级。结果本研究共纳入12例阴道内胚窦瘤,中位年龄14.5个月(9~21个月),平均肿瘤长径为4.1 cm。12例中有1例发生转移(髂窝淋巴结转移)。单纯化疗者在平均4个疗程后,7例(58.3%)获得CR,5例(41.7%)获得PR,无SD及PD患者。5例PR患者中,3例接受手术获得CR,术后病理证实为坏死肿瘤细胞;2例因拒绝手术继续采用BEP化疗方案,1例达到CR,其中淋巴结转移患者予化疗维持于PR。全部患者AFP水平于平均2.8个化疗周期后降至正常。平均随访101个月,无一例复发。结论阴道内胚窦瘤通过规范化疗可获得很好的治疗效果;BEP作为一线化疗方案,效果明显,多数患者可获得CR,长期随访无复发;对于获得PR的患者,手术治疗可有效去除残余结节,预防复发。Objective To explore the therapeutic efficacy and prognosis of BEP chemotherapy in children with vaginal endodermal sinus tumor(EST).Methods A retrospective review was conducted for medical records of children with vaginal EST from 2008 to 2020.The clinical manifestations,age of onset,tumor size and distant metastasis were recorded.All cases were diagnosed by preoperative pathological examinations.Follow-up methods included ultrasonography,computed tomography(CT)and serum level of alpha fetoprotein(AFP).The standard BEP chemotherapeutic regimen of bleomycin,etoposide and cisplatin was adopted.Prognostic evaluations were based upon the WHO criteria of general solid tumor efficacy:complete remission(CR),partial remission(PR),disease stability(SD),disease progression(PD).Results Twelve children were recruited with a median age of 14.5(9-21)years.The average tumor size was 4.1 cm.One child had iliac fossa lymph node metastasis.After an average of 4 chemotherapeutic courses,they achieved CR(n=7,58.3%)and PR(n=5,41.7%).Among 5 PR children,3 cases were operated for CR and postoperative pathology confirmed necrotic tumor cells.Two children turning down surgery received more cycles of BEP chemotherapy.One case achieved CR at Month 7 while another with lymph node metastasis maintained in PR.The elevated AFP returned to a normal level after an average of 2.8 cycles of chemotherapy.During a mean follow-up period of 101 months,there was no recurrence.Conclusion Vaginal EST may yield an excellent outcome through a standardized chemotherapy.As a first-line treatment protocol,BEP has an obvious efficacy.Most children can achieve CR and there is no recurrence during long-term follow-ups.For PR children,surgery can effectively remove residual nodules and prevent recurrence.

关 键 词：阴道肿瘤 肿瘤 生殖细胞和胚胎性 抗肿瘤联合化疗方案 治疗结果 儿童 

分 类 号：R737.34[医药卫生—肿瘤] R979.1[医药卫生—临床医学]