22例小儿肝母细胞瘤的临床分析

Analysis of clinical data of 22 children with hepatoblastoma

目的分析小儿肝母细胞瘤的临床资料,总结其临床诊治方案及经验,探讨可能影响其预后的因素。方法收集2009年1月至2014年12月间分期明确,经病理确诊且能随访的小儿肝母细胞瘤22例,均有完整的辅助检查资料。针对不同分期采用化疗联合手术的个体化规范化治疗并完成随访。结果按国际肿瘤协会（SLOP）Pretext临床分期,随访4~68个月,其中Ⅰ期、Ⅱ期共15例,复发2例,均存活,Ⅲ期4例,复发3例,1例死亡,Ⅳ期3例均复发,1例存活,1例多处转移,因多器官功能衰竭治疗无效死亡,1例复发肝功能衰竭死亡。结论肿瘤完整切除是小儿肝母细胞瘤治疗的关键点,化疗对实施根治性手术及预防肿瘤复发有重要意义,AFP水平、病理学分型、Pretext分期、多学科合作等是影响预后和复发的重要因素。

Objective To analyze the clinical data of children with hepatoblastoma,summarize clinical diagnosis and treatment plan and experience,and explore the factors that might affect prognosis of the patients. Methods 22 cases of hepatoblastoma,those who had clear stages,confirmed by pathology,and could be followed up from January,2009 to December,2014,were collected to the study. All of the patients had complete secondary examination data. Individualized and standardized treatment for different stages of chemotherapy combined with operation were provided to the patients. And follow-up visits were given to them. Results According to the International Cancer Association（ SLOP） Pretext clinical stage,the follow-up visits were given to patients for 4 to 68 months,which showed that 15 cases of stageⅠ and stage Ⅱwere all alive,with 2 cases relapsing. Of all the 4 cases of stage Ⅲ,3 cases relapsed,and 1 case died. 3 cases of stage Ⅳ all relapsed,with 1 case relapsing,1case with multiple metastasis died of multiple organ failure,and 1 case died of recurrence of liver failure. Conclusion Complete tumor resection is the key point in children with hepatoblastoma therapy,chemotherapy is of great significance in the implementation of radical operation and prevention of tumor recurrence. AFP levels,pathology classification,Pretext staging,multidisciplinary cooperation are factors affecting the prognosis and recurrence.