摘要
目的对23例NB和17例GNB临床资料进行生存分析,确定独立预后因子,制定新的可行性危险度分级计划。方法运用Cox回归模型,引入年龄、性别、INSS、病理类型、血NSE、24h尿VMA、血LDH和原发部位相关预后因子,进行多因素分析,确立独立预后因子。以独立预后因子为依据,计算每例患儿的预后指数(prognosticindex,PI),计算公式为:PI=b1x1+b2x2+…bnxn(b:回归系数,x:独立预后因子变量等级值)。以PI中位数为界值,PI≤中位数为低危组,PI>中位数为高危组,采用Kaplan-Meir生存曲线和Log-rank检验进行生存分析。结果年龄、INSS和24h尿VMA为独立预后因子,PI中位数为10.5145,低危组和高危组对生存率的影响差异具有统计学意义(P=0.001),说明低危组较高危组预后好。新的危险度分级计划为:确定年龄、INSS和24h尿VMA等级;计算PI,具体计算公式:PI=2.066Xage+1.285XVMA+1.268XINSS;确定危险度组别,低危组:PI≤10.5145;高危组:PI>10.5145。结论年龄、INSS和24h尿VMA为独立预后因子。由于上述独立预后因子临床上较易获得且Log-rank检验具有统计学意义,所以由此确立的新的危险度分级计划具有实用性和科学性,可以作为基层医生选择化疗强度和判断预后的依据。
Objective To explore the independent prognostic factors in neuroblastic tumors,and further to establish a new risk grouping system for neuroblastoma. Methods The clinical data including sex, age, INSS, pathological type, blood NSE, blood LDH and urine VMA of 24 h were analyzed in 23 NB and 17 GNB. To investigate independent prognostic factors, we used multi-variety analysis with Cox regression model. Based on independent prognostic factors, prognostic index (PI) was determined by following formula: PI=b1x1+b2x2+…bnxn(b: regression coefficient, x: grading value of independent prognostic factors. Regarding the median of PI as threshold value, we classified 23 NB and 17 GNB into two groups: low risk group and high risk group. Influence of low risk group and high risk group on the survival rate was analyzed by Kaplan-Meir curve and Log-rank test. All statistical tests were processed through SPSS 10. 0. Results Age, INSS and urine VMA of 24 h were independent factors. The median of PI was 10. 5145. Compared with high risk group, the low risk group had a higher survival rate(P = 0. 001 ). The new neuroblastoma risk group assignment schema was outlined by the following step : To definite the grading value of age,INSS and 24h urine VMA; PI was determined by the following formula: PI= 2. 066X age, + 1. 285X VMA + 1. 268X INSS; low risk group: PI≤0. 5145,high risk group: PI〉10. 5145. Conclusions The new grade system based on the Age, INSS and urine VMA of 24 h is practical and scientific. It can be used to predict the prognosis of children with neuroblastoma.
出处
《中华小儿外科杂志》
CSCD
北大核心
2006年第7期337-340,共4页
Chinese Journal of Pediatric Surgery