30例儿童卵黄囊瘤临床预后因素分析

The Analysis of Clinical Prognostic Factors of Thirty Children Patients with Yolk Sac Tumor

目的:对影响儿童卵黄囊瘤预后因素进行分析讨论。方法:自1989年到2002年随访30例,对年龄、性别、原发部位、Brodeur分期、血清AFP、化疗方案等进行多因素和单因素统计学分析。结果:Brodeur分期、化疗方案的选择是影响卵黄囊瘤2年无事件生存率的独立临床因素。Ⅰ到Ⅳ期的2年无事件生存率分别为76.92%、66.67%、40.00%和0;VAC及不规则化疗方案和铂类方案的2年EFS分别为18.18%和73.68%,有统计学差异。结论:儿童卵黄囊瘤的治疗为手术加辅助化疗的综合治疗,手术应以达到无肿瘤残留为目标。铂类方案的辅助化疗有助于提高疗效,但复发和转移病例的疗效仍有待提高。

Objective： To analyze the independent clinical prognostic factors of children patients with yolk sac tumor and to review related literatures. Methods： A total of 30 children patients with yolk sac tumor hospitalized between Jan 1989 to Dec 2002 were followed-up and six clinical factors, including age, sex, primary site, Brodeur stage, serum AFP and selection of chemotherapy regimen were statistically analyzed. Results： The independent clinical factors, such as Brodeur stage and selection of chemotherapy regimen, can affect 2-year event-free survivals （EFS） of yolk sac tumor in children. The 2-year EFS of Brodeur stage Ⅰ -Ⅳ was 76.92%, 66.67%, 40.00% and 0.00%, and that of VAC and BEP regimen were 18.18% and 73.68%, respectively. There was the stastisical significances. Conclusions： Muhi-modality management such as surgery and adjuvant chemotherapy was optimal for the patients with yolk sac tumor in children and adolescent. No residual tumor left after operation is the aim of surgery. Those with unresectable tumor can also receive wide margine excision after neoadjuvant chemotherapy. The appropriate adjuvant chemotherapy is needed and can improve the curative effect by BEP regimen, but enhancement for the outcomes of cases with recurrence and metastasis is still expected.