儿童颅外恶性实体肿瘤肺转移的不同治疗方式及预后分析  

Therapeutic approaches and prognostic outcomes for pulmonary metastases in pediatric extracranial malignant solid tumors

作　　者：汤梦婕[1] 袁晓军[1] TANG Mengjie;YUAN Xiaojun(Department of Pediatric Hematology/Oncology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院儿血液肿瘤科,上海200092

出　　处：《中国小儿血液与肿瘤杂志》2024年第6期407-411,共5页Journal of China Pediatric Blood and Cancer

摘　　要：目的分析伴有肺转移的颅外恶性实体肿瘤患儿的临床特征、治疗方式与预后因素。方法回顾性分析自2018年1月1日-2022年12月31日在上海交通大学医学院附属新华医院明确诊断的儿童颅外恶性实体肿瘤且同时伴有肺转移患儿的临床特征、病理类型、治疗方式及预后情况。结果共纳入57例伴有肺转移的颅外儿童恶性实体肿瘤患儿,男28例,女29例,中位诊断年龄为50.8(2.0-150.0)个月。39例(68.4%)肺部病灶经化疗/手术/放疗后达到完全缓解。本组患儿的3年总体生存率(OS)和3年无事件生存率分别为67.8%和56.8%;多发肺结节、存在肺外转移、肺转移灶未完全缓解患儿的3年OS分别为68.5%、63.6%和36.9%。多因素分析结果显示肺转移灶未完全缓解是独立不良预后因素,HR为13.6,95%CI为(3.9-46.3),P<0.0001。结论多发肺结节、存在肺外转移、肺转移灶未获完全缓解的患儿预后较差。化疗是诊断伴有肺转移儿童的首选治疗方式,手术切除和放疗可以作为化疗不敏感患儿的挽救性治疗,肺转移灶是否完全缓解是影响预后的关键因素。Objective To analyze the clinical characteristics,treatment modalities,and prognostic factors of pediatric extracranial malignant solid tumors with pulmonary metastases.Methods A retrospective analysis was conducted on the clinical characteristics,pathological types,treatment modalities,and prognostic outcomes of pediatric patients diagnosed with extracranial malignant solid tumors and concurrent pulmonary metastases at Xinhua Hospital,affiliated to Shanghai Jiao Tong University School of Medicine,from January 1,2018,to December 31,2022.Results The study included 57 pediatric patients with extracranial malignant solid tumors and pulmonary metastases,comprising 28 males and 29 females with a median diagnosis age of 50.8 months(range 2.0-150.0 months)old.Complete remission was achieved in 39 patients(68.4%)after chemotherapy,surgery,or radiotherapy.The 3-year overall survival rate(OS)and 3-year event-free survival rate(EFS)were 67.8%and 56.8%,respectively.For patients with multiple pulmonary nodules,extrapulmonary metastasis,and without complete remission pulmonary metastasis,the 3-year OS rates were 68.5%,63.6%,and 36.9%,respectively.Multivariate analysis showed that unresolved pulmonary metastasis(HR:13.6,95%CI:3.9-46.3,P<0.0001)was an independent adverse prognostic factor.Conclusions Children with malignant solid tumors with multiple pulmonary nodules,extrapulmonary metastasis,and without complete remission pulmonary metastasis have poor prognosis.Chemotherapy is the preferred treatment for children with pulmonary metastasis,surgical resection and radiotherapy can serve as salvage treatments for chemotherapy-insensitive patients.Complete remission of pulmonary metastases is a key prognostic factor.

关 键 词：儿童 恶性实体肿瘤 肺转移 预后 

分 类 号：R73[医药卫生—肿瘤]