INSS 4期神经母细胞瘤患儿3年无事件生存率的相关因素分析  

Risk factors related to 3-year EFS in International Neuroblastoma Staging System stage 4 neuroblastoma patients

作　　者：刘涛 盛庆丰[1] 刘江斌[1] 徐伟珏[1] 蒋莎义[1] 杨秀军 吕志宝[1] Liu Tao;Sheng Qingfeng;Liu Jiangbing;Xu Weijue;Jiang Shayi;Yang Xiujun;LüZhibao(Department of General Surgery,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200040,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普外科,上海200040

出　　处：《临床小儿外科杂志》2022年第2期121-127,共7页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨影响INSS 4期神经母细胞瘤患儿3年无事件生存率(event-free survival,EFS)的相关因素。方法回顾性分析2014年4月至2020年4月经上海市儿童医院确诊和完善评估的68例INSS 4期神经母细胞瘤患儿临床资料。收集患儿年龄、性别、神经元烯醇化酶(neuron specific enolase,NSE)、乳酸脱氢酶(1actate dehydrogenase,LDH)、24小时尿香草扁桃酸(vanillylmandelic acid,VMA)及肿瘤病理类型等信息。采用Kaplan-Meier法进行生存分析,采用Cox回归模型进行预后相关因素分析。随访时间1~60个月,平均随访时间21个月。结果68例INSS 4期神经母细胞瘤患儿中,男46例,女22例;发病年龄7~120个月,中位年龄35个月。其中48例(70.6%)伴骨髓转移,47例(69.1%)骨转移,17例(25.0%)远处淋巴结转移,9例(13.2%)肝转移,5例(7.4%)脑转移,4例(5.9%)眼眶转移,20例(29.4%)存在胸膜、皮肤等其他部位转移。单因素分析结果显示,患儿3年EFS与LDH、NSE、MYCN基因、骨转移、颅内转移(包括脑转移和眼眶转移)有关(P<0.05)。Cox回归分析结果显示,颅内转移(RR=4.179,95%CI=1.112~15.703,P=0.034)及血清LDH>587 U/L(RR=3.729,95%CI=1.116~12.466,P=0.033)是INSS 4期神经母细胞瘤患儿独立的预后相关因素。结论颅内转移、血清LDH>587 U/L与INSS 4期神经母细胞瘤患儿3年EFS相关。Objective To explore the risk factors related to 3-year event-free survival(EFS)in patients with International Neuroblastoma Staging System(INSS)stage 4 neuroblastoma(NB).Methods A retrospective analysis of 68 patients diagnosed and completely evaluated with INSS stage 4 neuroblastoma from April 2014 to April 2020 was performed.Patients'information including age,gender,neuron specific enolase(NSE),1actate dehydrogenase(LDH),vanillylmandelic acid(VMA),pathologic type,and so on were collected.Kaplan-Meier method and Cox regression were used for survival and prognostic factors analysis respectively.Follow-up in all patients ranged from 1 to 60 months(mean 21).Results Of the 68 patients(46 male,22 female)with INSS stage 4 neuroblastoma,the median age of onset was 35 months(7-120 months).There were 48 cases(70.6%)of bone marrow metastases,47 cases(69.1%)of bone metastases,17 cases(25.0%)of distant lymph node metastases,9 cases(13.2%)of liver metastases,5 cases(7.4%)of brain metastases 4 cases(5.9%)of orbital metastases,and 20 cases(29.4%)of other metastases.The univariate analysis revealed that 3-year EFS was associated with LDH,NSE,MYCN gene,bone metastasis,and intracranial metastasis(including brain metastases or orbital metastases)(P<0.05).The Cox analysis showed that intracranial metastasis(RR=4.179,95%CI=1.112~15.703,P=0.034)and LDH>587 U/L(RR=3.729,95%CI=1.116~12.466,P=0.033)were independent prognosis factors.Conclusion For patients with INSS stage 4 neuroblastoma,intracranial metastasis and LDH>587 U/L were independent prognosis factors for 3-year EFS.

关 键 词：神经母细胞瘤/外科学 抗肿瘤联合化疗方案 肿瘤转移 预后 

分 类 号：R739.4[医药卫生—肿瘤]