完成标准治疗方案后口服依托泊苷对播散髓母细胞瘤患儿的疗效及生存率观察研究  

Observation on the therapeutic efficacy and survival rate of oral Etoposide in children with disseminated medulloblastoma after the standard treatment plan

作　　者：刘晶晶 杜淑旭[1] 张金[1] 孙艳玲[1] 龚小军[1] 李舒婷[1] 王圆 刘妍 武万水[1] 孙黎明[1] Liu Jingjing;Du Shuxu;Zhang Jin;Sun Yanling;Gong Xiaojun;Li Shuting;Wang Yuan;Liu Yan;Wu Wanshui;Sun Liming(Department of Pediatrics,Beijing Shijitan Hospital of Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院儿科,北京100038

出　　处：《中华实用儿科临床杂志》2023年第5期339-342,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨完成标准治疗方案后继续口服依托泊苷对播散髓母细胞瘤(MB)患儿的疗效及不良反应。方法回顾性分析2016年1月至2020年5月首都医科大学附属北京世纪坛医院儿科收治的播散MB患儿86例的临床资料,患儿中位年龄8.8(3.0~16.7)岁,其中口服依托泊苷维持化疗患儿33例(化疗组),未口服维持化疗患儿53例(未化疗组)。比较2组患儿的性别、手术切除范围、病理类型、分子分型、术后缄默状态、M分期及生存情况[无进展生存期(PFS)及总体生存期(OS)]。记录口服依托泊苷化疗的主要不良反应。采用χ^(2)检验进行资料比较,采用Kaplan-Meier绘制播散MB患儿的生存曲线,Log-rank检验差异是否有统计学意义。结果2组患儿的性别、手术切除范围、病理类型、分子分型、术后缄默状态及M分期比较,差异均无统计学意义(均P>0.05)。86例患儿的中位PFS为3.0(0.2~6.3)年,复发25例(29.1%),中位OS为3.6(0.5~6.3)年,死亡13例(15.1%)。未化疗组3年、5年PFS率分别为(65.8±6.8)%、(56.8±7.7)%;化疗组3年、5年PFS率分别为(82.0±7.3)%、(82.0±7.3)%,2组比较差异有统计学意义(P=0.037)。未化疗组3年、5年OS率分别为(81.6±5.6)%、(71.2±7.7)%;化疗组3年、5年OS率分别为100.0%、(92.3±7.4)%,2组比较差异有统计学意义(P=0.025)。分子分型为SHH的患儿中,规律治疗后口服依托泊苷维持化疗的患儿PFS率较未口服维持化疗的患儿高(100.0%比57.1%),差异有统计学意义(P=0.021)。口服依托泊苷化疗的主要不良反应为骨髓抑制和胃肠道反应,经对症治疗后可缓解,未出现口服化疗相关的病例死亡。结论播散MB患儿预后相对较差,经标准治疗后口服依托泊苷维持治疗有利于减少复发,提高患儿的5年生存率,且患儿耐受良好。Objective To explore the therapeutic efficacy and toxicity of oral Etoposide chemotherapy in children with disseminated medulloblastoma(MB)after the standard treatment plan.Methods The clinical data of 86 children with disseminated MB admitted in the Department of Pediatrics,Beijing Shijitan Hospital of Capital Medical University from January 2016 to May 2020 were analyzed retrospectively.The median age of children was 8.8(3.0-16.7)years old.Among them,33 children treated with maintenance chemotherapy via oral Etoposide were included in the chemotherapy group,and 53 children without oral maintenance chemotherapy were included in the non-chemotherapy group.The gender distribution,surgical resection range,pathological type,molecular classification,postoperative mutism,M-stage and survival[progression-free survival(PFS)and overall survival(OS)]of the 2 groups were compared.The main adverse events of oral Etoposide chemotherapy were recorded.Chi-square test is used for data comparison,Kaplan-Meier method was used to plot the survival curve of disseminated MB patients,followed by the Log-rank test.Results There were no significant differences in gender,surgical resection range,pathological type,molecular typing,postoperative mutism and M-stage between the 2 groups(all P>0.05).Of 86 patients,the median PFS and OS were 3.0(0.2-6.3)years,and 3.6(0.5-6.3)years,respectively.Twenty five cases(29.1%)relapsed,13 cases(15.1%)died.The 3-year[(65.8±6.8)%vs.(82.0±7.3)%]and 5-year PFS[(56.8±7.7)%vs.(82.0±7.3)%]in non-chemotherapy group were significantly lower than those of chemotherapy group(P=0.037).The 3-year[(81.6±5.6)%vs.100.0%]and 5-year OS[(71.2±7.7)%vs.(92.3±7.4)%]in non-chemotherapy group were significantly lower than those of chemotherapy group(P=0.025).Among the children with the SHH subtype,the PFS of children with oral Etoposide maintenance chemotherapy after a regular treatment was significantly higher than that without oral maintenance chemotherapy(100.0%vs.57.1%)(P=0.021).The major adverse events of oral Eto

关 键 词：儿童 播散 髓母细胞瘤 依托泊苷 口服化疗 

分 类 号：R739.41[医药卫生—肿瘤]