基于甲胎蛋白临床诊断肝母细胞瘤行新辅助化疗可行性分析  

Feasibility of the neoadjuvant chemotherapy for children with hepatoblastoma diagnosed by serum alpha-fetoprotein

作　　者：廖雪莲[1] 蒋莎义[1] 杨静薇[1] 邵静波[1] 刘江斌[2] 吕志宝[2] 吴于淳[3] 王雪莉[4] LIAO Xuelian;JIANG Shayi;YANG Jingwei;SHAO Jingbo;LIU Jiangbin;LYU Zhibao;WU Yuchun;WANG Xueli(Department of Hematology&Oncology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China;Department of General Surgery,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Radiology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Pathology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院血液肿瘤科,上海200062 [2]上海市儿童医院上海交通大学附属儿童医院普外科,上海200062 [3]上海市儿童医院上海交通大学附属儿童医院影像科,上海200062 [4]上海市儿童医院上海交通大学附属儿童医院病理科,上海200062

出　　处：《临床儿科杂志》2021年第8期596-599,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨基于血清甲胎蛋白(AFP)升高和肝脏影像学的临床诊断行经验性新辅助化学治疗在儿童肝母细胞瘤临床诊疗中的可行性。方法回顾分析近5年收治的80例原发肝占位患儿的临床资料,其中肝母细胞瘤50例和非肝母细胞瘤30例。分析血清AFP对临床诊断儿童原发肝占位为肝母细胞瘤的灵敏度和特异度;根据化疗前是否有病理证据将50例肝母细胞瘤患儿分为经验性化疗组和有病理化疗组,比较两组最终病理结果、总生存率(OS)和无事件生存率(EFS)。结果血清AFP异常升高诊断儿童原发肝占位为肝母细胞瘤的灵敏度为98%,特异度100%;与病理诊断的一致性高(Kappa=0.97,P<0.001)。肝母细胞瘤经验性化疗组和有病理化疗组3年OS分别为88.3%和90.7%,EFS分别为74.8%和81.3%;经Log-rank检验,OS和EFS的差异均无统计学意义(P>0.05)。经COX回归分析发现,在校正年龄、性别因素后,化疗前有无病理证据对PRETEX分期Ⅲ、Ⅳ期肝母细胞瘤3年OS和EFS影响无统计学意义(HR=4.68,95%CI:0.55~39.91;HR=2.34,95%CI:0.53~10.28)。结论根据血清AFP明显升高,可鉴别儿童肝母细胞瘤与其他儿童原发肝占位性疾病。基于血清AFP升高临床诊断肝母细胞瘤可指导手术耐受差的患儿术前新辅助化疗,降低手术风险。Objective Surgical pathology is the gold standard for the diagnosis of hepatoblastoma,but when the tumor is large and the general condition is poor,even the biopsy will put the child at greater risk.Wethether neoadjuvant chemotherapy can be carried out according to clinical diagnosis is still lack of research reports.The purpose of this study was to investigate the feasibility of neoadjuvant chemotherapy based on elevated serum alpha-fetoprotein(AFP)and liver imaging in the clinical practice of pediatric hepatoblastoma.Methods A retrospective analysis was made on clinical data of 80 children with primary hepatic space-occupying lesions admitted to a single center in the past 5 years,including 50 cases of hepatoblastoma and 30 cases of non-hepatoblastoma.Among the 50 children with hepatoblastoma,those who had pathological evidence before neoadjuvant chemotherapy were classified as the pathological treatment group,and those who started chemotherapy according to the clinical diagnosis of hepatoblastoma based on the elevation of AFP were assigned to the empirical chemotherapy group.The consistency of clinical diagnosis with pathological diagnosis and the survival of the two groups were.Results According to the elevation of serum AFP,the liver primary occupying lesions in children was clinically determined as hepatoblastoma.The sensitivity and specificity were 98%and 100%.There was no significant difference in overall survival(OS)and event-free survival(EFS)between the two groups by the log-rank test.Conclusions The diagnosis of hepatoblastoma based on the elevated serum AFP can be used to guide the preoperative neoadjuvant chemotherapy in children with poor surgical tolerance and to minimize the risk of treatment.

关 键 词：血清甲胎蛋白 肝占位 肝母细胞瘤 儿童 

分 类 号：R735.7[医药卫生—肿瘤]