儿童肝母细胞瘤一线治疗结束时血清甲胎蛋白水平与预后关系分析  

Relationship between serum level of alpha-fetoprotein at the end of treatment and prognosis in hepatoblastoma children

作　　者：李卓苒 韦芷晴 黄俊廷[1] 王娟[1] 孙斐斐[1] 朱佳[1] 路素英[1] 张翼鷟 孙晓非[1] 甄子俊[1] Li Zhuoran;Wei Zhiqing;Huang Junting;Wang Juan;Sun Feifei;Zhu Jia;Lu Suying;Zhang Yizhuo;Sun Xiaofei;Zhen Zijun(Department of Pediatric Oncology,Collaborative Innovation Center of Oncology,State Key Laboratory of Oncology in South China,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心儿童肿瘤科,华南肿瘤学国家重点实验室,广州510060

出　　处：《中华小儿外科杂志》2024年第11期978-984,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童肝母细胞瘤一线治疗结束时血清甲胎蛋白(alpha-fetoprotein, AFP)水平与预后的关系。方法收集2007年12月至2022年5月中山大学肿瘤防治中心儿童肿瘤科收治的72例18岁以下的肝母细胞瘤患儿的临床资料, 其中男42例, 女30例, 确诊时中位年龄为27.8(0.3~150.3)个月, 3岁以下患儿占69.4%(50/72)。所有患儿确诊后完成标准一线治疗, 主要观察指标为无事件生存率(event free survival, EFS)、总生存率(overall survival, OS)。采用χ^(2)检验、生存分析、多因素COX回归等方法评估患儿预后危险因素。结果极低、低、中和高危患儿分别有2、14、25、31例。一线治疗结束时AFP≤10 ng/ml的患儿占63.9%(46/72), 达影像学完全缓解者占76.4%(55/72)。AFP≤10 ng/ml组复发率明显低于AFP>10 ng/ml组(15.2%比65.4%, χ^(2)=20.0, P<0.001)。两组3年EFS分别为80.7%和31.4%(P<0.01), 3年OS分别为96.6%和63.0%(P<0.01)。一线治疗结束时达影像学完全缓解患儿中, AFP≤10 ng/ml组3年EFS、OS均显著优于AFP>10 ng/ml组。未达影像学完全缓解患儿中, AFP≤10 ng/ml组3年OS优于AFP>10 ng/ml组。多因素分析发现一线治疗结束时AFP>10 ng/ml是独立不良预后因素。结论儿童肝母细胞瘤一线治疗结束时血清AFP未降至10 ng/ml以下的患儿预后不良, 应增强治疗。Objective:To explore the association between serum level of alpha-fetoprotein(AFP)at the end of first-line therapy and the prognosis of patients with hepatoblastoma(HB).Methods:From December 2007 to May 2022,the relevant clinical data were retrospectively reviewed for 72 HB patients aged under 18 year.There were 42 boys and 30 girls with a median diagnostic age at 27.8(0.3-150.3)month.And 69.4%of them were aged under 3 year.All of them completed a first-line therapy after a definite diagnosis.Two major outcome parameters were event-free survival(EFS)and overall survival(OS).Chi-square test,survival analysis and COX proportional hazards model were utilized for evaluating the risk factors of prognosis of HB patients.Results:Two,14,25 and 31 patients were classified into very-low-risk,low-risk,median-risk and high-risk groups.After a first-line therapy,46/72 patients(63.9%)had serum level of AFP≤10 ng/ml and 55/72 patients(76.4%)achieved complete remission(CR)as evaluated by imaging.Recurrence rate in individuals with AFP>10 ng/ml was significantly higher than those with AFP≤10 ng/ml(65.4%vs 15.2%),3-year event-free survival(3yr-EFS)was 31.4%and 80.7%(P<0.01)and overall survival(OS)63.0%and 96.6%(P<0.01).For CR cases,3yr-EFS/OS was higher among individuals with AFP≤10 ng/ml than those with AFP>10 ng/ml.Even without CR,3yr-EFS was considerably higher in AFP≤10 ng/ml group.Multivariate analysis indicated that AFP>10 ng/ml after a first-line therapy was an independent predictor.Conclusion:The prognosis of HB patients without serum AFP≤10 ng/ml after a first-line therapy remains poor and treatment should be intensified.

关 键 词：肝母细胞瘤 甲胎蛋白 危险分层 预后 儿童 

分 类 号：R735.7[医药卫生—肿瘤]