儿童神经母细胞瘤预后因子及危险度分级计划探讨

Prognostic factors and new risk group assignment schema in neuroblastoma

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.