摘要
目的 分析儿童Ⅲ期神经母细胞瘤（NB）的诊治方案、远期疗效及影响预后因素.方法 回顾性分析1999年1月至2007年5月在我院初诊并接受NB-99方案治疗和随访的Ⅲ期NB患儿.结果 在101例NB患儿中,Ⅲ期患儿30例,占29.7%,其中男性患儿19例,女性患儿11例.诊断时年龄（33±30）个月.原发部位以腹部和后纵隔多见,分别为16例和10例.病理分型为预后良好型者21例.11例患儿进入中危组治疗;6例患儿在化疗后行自体造血干细胞移植;5例在化疗后未接受维甲酸治疗.随访期5-96个月,中位随访时间43个月.28例患儿在治疗中达完全缓解,有7例出现复发,总的无事件生存率和存活率分别达74%±9%和77%±8%.单因素分析显示初诊时病理分型、乳酸脱氢酶（LDH）水平、血清铁蛋白（SF）水平和是否进行维甲酸治疗与Ⅲ期NB患儿的预后相关（X2=9.48、6.82、9.17、9.06,均P〈0.05）;多因素分析显示LDH、SF、维甲酸治疗和干细胞移植与预后相关（OR=3.95、3.44、2.64、1.27,均P〈0.05）.结论 儿童Ⅲ期NB疗效受LDH、SF、维甲酸治疗和干细胞移植等因素影响.
Objective To evaluate the long-term outcomes of childhood stage Ⅲ neuroblastoma （NB） and its associated prognostic factors.Methods Children with newly diagnosed NB were enrolled into the protocol of NB-99 and followed up from January 1999 to May 2007.The relevant data were collected.And the statistics was processed by SPSS 10.0.Results Thirty children with stage ill NB were found among all 101 children with NB.There were 19 males and 11 females.The mean age at diagnosis was （33±30） months.Abdomen and thorax were by far the most common sites of primary tumor （16 and 10 respectively）.Twenty-one NB children had favorable pathology classification Eleven NB children were treated according to the mediate-risk protocol,6 children received autologous stem cell transplantation （ASCT） after chemotherapy and 5 patients had no therapy of cis-retinoic acid.Follow-up was conducted for 5-96 months.A complete response or an excellent partial remission was observed in 28 patients.Seven patients relapsed or progressed at the primary tumor site or bone marrow.The estimated cumulative probabilities of event-free survival and overall survival at 4 years for these 30 patients were 74%±9% and 77%±8% respectively.On univariate analysis,pathological type,high levels of LDH and ferritin,non-therapy of cis-retinoic acid were associated with a worse survival （X2=9.48,6.82,9.17,9.06,all P〈0.05）.As to the multivariate estimates of hazards ratio,high levels of LDH and ferritin,no ASCT and non-therapy of cis-retinoic acid were associated with a worse survival （OR=3.95,3.44,2.64,1.27,all P〈0.05）.Conclusion Stage Ⅲ NB children with favorable histologic features,normal LDH,normal serum ferritin,receive ASCT,and treated with cis-retinoic acid have a lower risk of relapse.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第22期1556-1558,共3页
National Medical Journal of China
基金
上海市科学技术委员会重点科技支撑计划（08411953700）
