术前神经元特异性烯醇化酶与手术时机对高危神经母细胞瘤患儿预后的影响  

Effect of pre-operative neuron specific enolase and operation timing on prognosis of children with high risk neuroblastoma

作　　者：蒋持怡 秦红[2] 于彤[3] 王焕民[2] 马晓莉 JIANG Chiyi;QIN Hong;YU Tong;WANG Huanmin;MA Xiaoli(National Children′s Medical Center,Beijing Key Laboratory of Pediatric Hematology Oncology,National Key Discipline of Pediatrics,Ministry of Education,Ministry of Education(MOE)Key Laboratory of Major Diseases in Children,Hematology Oncology Center,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;National Children′s Medical Center,Surgical Oncology,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;National Children′s Medical Center,Image Center,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血液肿瘤中心,儿童血液病与肿瘤分子分型北京市重点实验室,儿科学国家重点学科,儿科重大疾病研究教育部重点实验室,北京100045 [2]首都医科大学附属北京儿童医院肿瘤外科,北京100045 [3]首都医科大学附属北京儿童医院影像中心,北京100045

出　　处：《中国小儿血液与肿瘤杂志》2021年第6期348-353,共6页Journal of China Pediatric Blood and Cancer

基　　金：国家科技重大专项(2017ZX09304029004)。

摘　　要：目的分析高危神经母细胞瘤(HR-NB)患儿术前神经元特异性烯醇化酶(NSE)水平和手术时机的关系,探讨其对预后的影响,旨在寻求最佳手术时机以提高HR-NB患儿生存率。方法选择2017年1月—2018年12月在首都医科大学附属北京儿童医院确诊为HR-NB,且原发瘤灶均在腹膜后/肾上腺区,并接受规律治疗的105例患儿,回顾性总结其临床资料,根据不同术前NSE水平和手术时机,分析NSE变化,并评估预后。结果105例患儿中位随访时间23.25(18.125~30)个月。术前接受5次化疗组的NSE降低速度比化疗3次和4次组快。化疗3次组的总生存率(OS)和无事件生存率(EFS)高于化疗4次和5次组患儿。术前NSE≥21.9ug/L的患儿3年OS和EFS分别为78.97%和39.88%,比NSE<21.9ug/L的患儿低。43例4次化疗后NSE仍高于21.9ug/L的患儿中,继续化疗1次组患儿术后NSE下降速度比即刻手术患儿快,随访中疗效更佳。结论HR-NB患儿接受3-5次化疗后进行手术较为适宜。术前NSE监测可作为评估手术条件的重要指标之一,其水平高时适当延迟手术有利于NSE恢复和预后改善,具有一定的安全性。Objective To analyze the relationship between preoperative neuron-specific enolase(NSE)and operation timing in children with high-risk neuroblastoma(HR-NB).To explore NSE impact on prognosis,aiming to find the best operation time to improve the survival rate of children with HR-NB.Methods 105 children who were diagnosed with HR-NB in Beijing Children′s Hospital affiliated to Capital Medical University from January 2017 to December 2018 were summarized retrospectively.They all had primary adrenal peritoneum and received regular treatment.According to NSE levels before operation and operation timing,the relationship between the two factors and prognosis was analyzed.Results The median follow-up time of 105 children was 23.25(18.125,30)months.The rate of NSE decreased levels in 5 chemotherapy groups were faster than in 3 and 4 chemotherapy groups.The 3-year OS and EFS of children whose preoperative NSE≥21.9ug/L were 78.97%and 39.88%,which were lower than those whose preoperative NSE<21.9ug/L.Among the 43 children whose NSE was still higher than 21.9ug/L after 4 cycles of chemotherapy,NSE of children who continued chemotherapy for one cycle decreased faster than that take immediate operation.And their curative effect were better during follow-up.Conclusions It′s appropriate time to have an operation for children with HR-NB after 3-5 cycles of chemotherapy.Preoperative NSE monitoring can be used as one of the important indicators to evaluate surgical conditions.Properly delaying the operation when the preoperative NSE level is high is conducive to the recovery of NSE and the improvement of prognosis.And it has certain safety.

关 键 词：高危神经母细胞瘤 神经元特异性烯醇化酶 手术时机 预后 

分 类 号：R739.4[医药卫生—肿瘤]