85例儿童卵黄囊瘤的临床特点及预后分析  

Clinical characteristics and prognoses of yolk sac tumor:a report of 85 children

作　　者：汪刚 潮敏[1] 张晔 张殷 Wang Gang;Chao Min;Zhang Ye;Zhang Yin(Department of Pediatric Surgery,Affiliated Provincial Children's Hospital,The Fifth Medical School,Anhui Medical University,Hefei 230051,China)

机构地区：[1]安徽医科大学附属省儿童医院,安徽医科大学第五临床医学院,合肥230051

出　　处：《中华小儿外科杂志》2024年第5期385-392,共8页Chinese Journal of Pediatric Surgery

基　　金：安徽省高等学校科学研究重点项目(2023AH050665)。

摘　　要：目的探讨小儿卵黄囊瘤的临床特点及预后影响因素。方法收集2010年1月至2018年8月在安徽省儿童医院就诊的卵黄囊瘤85例患儿临床特征、治疗和预后的临床资料。采用Kaplan-Meier法绘制生存曲线;采用单因素及多因素Cox比例风险回归模型分析患儿预后的影响因素。结果85例患儿中位年龄为20.5(0.03~166.6)个月,中位随访时间为62.1(1.5~133.1)个月,5年总体生存率为87.1%(95%CI:79.7%~94.5%),5年无进展生存率为79.8%(95%CI:70.6%~89.0%)。单因素Cox回归分析显示:生活地区、远处转移、延迟化疗、术前血清甲胎蛋白、术后2个月血清甲胎蛋白、复发均与其预后有相关性(P<0.05),是影响患儿生存的危险因素。多因素Cox回归分析显示,居住于农村地区(HR=7.830,95%CI:1.60~38.41,P=0.011)、延迟化疗(HR=5.323,95%CI:1.14~25.64,P=0.047)、术后2个月血清甲胎蛋白未降至正常(HR=15.704,95%CI:1.65~149.18,P=0.017)、肿瘤复发(HR=26.046,95%CI:3.03~224.07,P=0.003)是影响预后的独立危险因素。结论生活于农村地区、延迟辅助化疗、术后2个月内甲胎蛋白未恢复正常、肿瘤复发可能提示预后不良,需要根据生活地区、化疗意愿、治疗后持续监测甲胎蛋白与影像学表现,对卵黄囊瘤儿童进行个体化治疗和随访。Objective To explore the clinical characteristics and prognostic factors of yolk sac tumor(YST)in children.Methods From January 2010 to August 2018,clinical characteristics,treatments and prognoses were retrospectively reviewed for 85 YST children.Survival curve was plotted by Kaplan-Meier method.Univariate and multivariate Cox proportional hazard regression models were utilized for examining the prognostic factors.Results Median age was 20.5(0.03-166.6)months,median follow-up period 62.1(1.5-133.1)months,5-year overall survival(OS)87.1%(95%CI:79.7%-94.5%)and 5-year progression-free survival(PFS)79.8%(95%CI:70.6%-89.0%).Univariate Cox regression analysis indicated that residing region,delay of adjuvant chemotherapy(DAC),preoperative alpha-fetoprotein(AFP),AFP not normalized within 2 months postoperatively and tumor recurrence were risk factors affecting the OS of YST children.Multivariate Cox regression analysis revealed that rural residing(HR=7.830,95%CI:1.60-38.41,P=0.011),DAC(HR=5.323,95%CI:1.14-25.64,P=0.047),AFP not normalized within 2 months postoperatively(HR=15.704,95%CI:1.65-149.18,P=0.017)and tumor recurrence(HR=26.046,95%CI:3.03-224.07,P=0.003)were independent risk factors for prognosis.ConclusionRural residing,DAC,AFP not normalized within 2 months postoperatively and tumor recurrence hint at a poor prognosis.Clinicians should individualize treatments and conduct regular follow-ups of imaging for YST children according to residing region,intent of chemotherapy and level of AFP.

关 键 词：内胚层窦瘤 卵黄囊瘤 预后 儿童 

分 类 号：R737[医药卫生—肿瘤]