儿童胸腔巨大肿瘤临床特点及预后因素分析

Prognostic Analysis of Postoperative Children with Gigantic Thoracic Tumors

目的探讨儿童胸腔巨大肿瘤临床特点及影响预后的相关因素。方法回顾性分析上海交通大学附属儿童医院心胸外科2009年1月~2015年6月收治的76例经手术治疗的原发性胸腔巨大肿瘤患者的临床病理资料,采用Kaplan-Meier法行单因素生存分析。结果本组良性肿瘤35例,以神经节细胞瘤多见(12例),其次为脉管瘤(9例),畸胎瘤(8例);恶性肿瘤41例,以神经母细胞瘤多见(13例),其次为神经节母细胞瘤(7例)和淋巴瘤(7例)。参与随访的70例胸腔巨大肿瘤患者5年生存率>75%;39例胸腔巨大恶性肿瘤患者5年生存率>50%。Kaplan-Meier法单因素分析显示,患者性别、肿瘤胸腔内原发部位等与神经源性肿瘤预后无相关性(P>0.05),而患者年龄、肿瘤临床分期、肿瘤病理类型、术后是否化疗则与神经源性肿瘤预后有相关性(P<0.05)。结论手术切除是胸腔巨大良性肿瘤预后相关因素;胸腔巨大恶性肿瘤复发率、转移率高,预后差,术后结合化疗/放疗可延长患者生存时间;儿童胸腔巨大肿瘤以神经源性肿瘤多见,患者性别、肿瘤胸腔内原发部位等与神经源性肿瘤预后无相关性,而患者年龄、肿瘤临床分期、肿瘤病理类型、是否辅助化疗是神经源性肿瘤预后相关因素。

Objective To investigate the clinical features and prognostic factors of children with gigantic thoracic tumors. Methods Clinical data were collected from the database of Cardiothoracic Surgery, Shanghai Children＇s Hospital between January 2009 and June 2015. The analyses were mainly focused on the clinical data of 76 cases of thoracic giant tumor that underwent surgical treatment, Univariate survival analysis was performed with Kaplan Meier method. Results Pathological results showed that 35 cases were benign tumors and 41 cases were malignant tumors. For benign tumors, the main pathological classification were ganglioneuroma in 12 cases, vascular tumors in 9 cases, germ cell tumors in 8 eases. For malignant tumors , the main pathological classification were neuroblastoma in 13 cases, ganglioneuroblastoma in 7 cases and lymphoma in 7 cases, etc. After surgical resection 31 cases of benign tumors were long -term survival. The 5 year survival rates of 70 patients with gigantic thoracic tumors was more than 75% , 39 patients with malignant tumors were more than 50%. Single factor in Kaplan Meier analysis showed that gender, location of primary tumor were not associated with neurogenic tumor prognosis（ P 〉 0.05 ）. The age of patients, tumor stage, tumor pathological type, whether chemotherapy are associated with prognosis of neurogenic tumors the difference has statistical significance （P 〈 0.05）. Conclusion Surgical resection is a prognostic factor for patients with benign thoracic giant tumor. The recurrence and metastasis rates of malignant tumor is high. Its prognosis is poor. The survival time of patients with postoperative chemotherapy or radiotherapy can be prolonged. The most common children gigantic thoracic tumors are neu- rogenic tumors, There is no correlation between the prognosis of neurogenic tumors and sex or primary site. While age, tumor stage, pathology and whether with chemotherapy are associated with neurogenic tumor prognosis.