基于影像学危险因素评价化疗对于减少中高危腹膜后神经母细胞瘤手术并发症的作用研究  

Evaluation of chemotherapy for reducing operative complications of medium and high risk retroperitoneal neuroblastoma based on imaging-defined risk factor

作　　者：胡嘉健 孙记航[2] 杨深 陈艺伟 王焕民[1] Hu Jiajian;Sun Jihang;Yang Shen;Chen Yiwei;Wang Huanmin(Department of Pediatric Oncological Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing,China,100045;Department of Radiology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing,China,100045;the Department of Pediatric Oncology,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China)

机构地区：[1]国家儿童医学中心(北京),首都医科大学附属北京儿童医院肿瘤外科,北京100045 [2]国家儿童医学中心(北京),首都医科大学附属北京儿童医院影像科,北京100045 [3]天津医科大学肿瘤医院儿童肿瘤科,天津300060

出　　处：《临床小儿外科杂志》2022年第2期108-114,共7页Journal of Clinical Pediatric Surgery

基　　金：中国工程院咨询研究课题(2019-XY-34)。

摘　　要：目的基于影像学危险因素(image-defined risk factor,IDRF)概念,探讨化疗对于减少中高危腹膜后神经母细胞瘤手术并发症的作用。方法回顾性分析2016年6月至2017年6月在首都医科大学附属北京儿童医院行规范化疗后完整切除肿瘤的中高危腹膜后神经母细胞瘤患儿临床及影像学资料。采用国际神经母细胞瘤危险度分级协作组(International Neuroblastoma Risk Group,INRG)标准定义IDRF。记录化疗前及化疗后(手术前)每例患儿的IDRF情况并进行比较。采用Spearman相关系数法分析化疗后(手术前)IDRF数目与并发症项数之间的相关性,P<0.05为差异有统计学意义。结果本研究共纳入神经母细胞瘤患儿53例,其中男22例,女31例;起病月龄4~148个月,平均月龄(39.60±28.70)个月。化疗前IDRF数目范围为0~11项(中位数4项),化疗后(手术前)IDRF数目范围0~11项(中位数3项),化疗前后IDRF的数目变化差异有统计学意义(P<0.05);37例出现并发症,共计74项,各例项数范围0~4项(中位数1项)。各例手术并发症项数与化疗后(手术前)各例IDRF数目存在较强的相关性(r=0.687,P<0.05)。结论化疗能够有效减少中高危腹膜后神经母细胞瘤的IDRF,降低手术风险。IDRF对于手术风险的评估具有重要价值。Objective To research the role of neoadjuvant chemotherapy in reducing operative complications of medium and high risk retroperitoneal neuroblastoma based on the concept of imaging-defined risk factor(IDRF).Methods The whole clinical and surgical data of children with medium and high risk retroperitoneal neuroblastoma who underwent standardized chemotherapy and surgery from June 2016 to June 2017 in Beijing Children's Hospital were retrospectively analyzed.IDRF were defined according to the international neuroblastoma risk group(INRG)standard.Changes in IDRF during diagnosis and treatment were recorded.We compared IDRF before and after chemotherapy in each patient.The correlation between the number of preoperative IDRF and the number of surgical complications was analyzed by spearman correlation coefficient method(P value<0.05 was statistically significant).Results A total of 53 cases were collected,including 22 boys and 31 girls.The age of onset ranged from 4 to 148 months,with an average of 39.60±28.70 months.The number of IDRFs ranged from 0 to 11(median 4 items)before chemotherapy and from 0 to 11(median 3 items)after chemotherapy.The change of IDRFs had statistical significance(P<0.05).A total of 74 complications occurred in 37 patients,with a maximum of 4 complications and a minimum of 0 complications(median of 1 complications)in each patient.There was a strong correlation between the number of operative complications and the number of preoperative IDRFs(r=0.687,P<0.05).Conclusion Chemotherapy can effectively reduce IDRF and surgical risk.IDRF is of great value in the assessment of surgical risk.

关 键 词：神经母细胞瘤/外科学 神经母细胞瘤/治疗 手术中并发症 手术后并发症 抗肿瘤联合化疗方案 儿童 

分 类 号：R735.4[医药卫生—肿瘤]