儿童及青少年消化道恶性实体瘤临床分析

Clinical analysis of malignant solid tumors in the digestive tract in children and adolescents

目的探讨儿童及青少年消化道恶性实体肿瘤的临床特点、治疗手段和预后。方法选取1997年1月至2017年6月在郑州大学附属肿瘤医院/河南省肿瘤医院住院治疗的儿童及青少年恶性消化道实体肿瘤65例，收集患儿发病部位、性别、年龄、临床表现、治疗方法、随访时间、随访截止日生存状态等资料，分析其临床特征、治疗手段及预后，随访时间至2017年12月31日。结果65例患儿中，肝脏肿瘤最常见[36例（55.38%）]，其次是直肠11例（16.92%）、结肠6例（9.23%）、胰腺5例（7.69%）、胃3例（4.62%），食管、胆囊、回肠、阑尾各1例。男童发病率高于女童，男女之比为1.321.00。胚胎性肿瘤发病年龄偏小，上皮性癌发病年龄偏大。腹胀、腹痛为最常见症状，占66.15%（43/65例）。Ⅳ期肿瘤占41.5%（27/65例）。根治和姑息手术治疗是最主要手段[50例（76.92%）]。1年、2年、3年总生存率（OS）分别为60.7%、31.0%、18.8%。结肠癌、直肠癌OS均高于肝细胞癌（χ2＝6.268，P＝0.012；χ2＝11.772，P＝0.001）。手术联合化放疗组患儿生存期最长，单纯化疗组最短，但单纯手术、单纯化疗、手术联合化疗、手术联合化放疗4组间生存率差异均无统计学意义（均P〉0.05）。结论儿童及青少年消化道恶性实体肿瘤预后差，临床症状缺乏特异性，早期诊断、尽早采取手术、化疗、放疗等综合治疗手段，对延长生存期有重要意义。

ObjectiveTo explore the clinical features, treatment and prognosis of malignant solid tumors in the digestive tract in children and adolescents.MethodsSixty-five children and adolescents with malignant solid tumors in the digestive tract from January 1997 to June 2017 were selected, who were treated at the Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital.The tumor site, gender, age, clinical presentations, treatment, follow-up time and their life status by deadline follow-up in 65 children and adolescents were collected respectively, and the clinical features, treatment methods and prognosis were retrospectively analyzed.The follow-up deadline was on December 31, 2017.ResultsThe most frequent sites of tumors were liver tumor（36 cases, 55.38%）, followed by rectum tumor（11/65 cases, 16.92%）, colon tumor（6/65 cases, 9.23%）, pancreas tumor（5/65 cases, 7.69%）, gastric（3/65 cases, 4.62%）, esophagus（1/65 cases, 1.54%）, gallbladder tumor（1/65 cases, 1.54%）, ileum tumor（1/65 cases, 1.54%）, and appendix tumor（1/65 cases, 1.54%）. The prevalence rate in males and females was 1.321.00.The age of embryo tumor incidence was smaller, and the age of epithelium cancer incidence was older.The main symptoms included abdominal distension and pain （66.15%, 43/65 cases）. Twenty-seven patients （41.5%, 27/65 cases） was in stage Ⅳ.Radical and palliative surgery were the main treatment in 50 cases （76.92%）. The 1-year, 3-year, 5-year overall survival rates were 60.7%, 31.0%, 18.8%, respectively.The overall survival rate of colon and rectal cancer was higher than that of hepatocellular cancer, and the differences were all statistically significant（χ2=6.268, P=0.012; χ2=11.772, P=0.001）. The overall survival rate of patients who received surgery combined with chemoradiotherapy was the longest and those undergoing chemotherapy only was the shortest, but the differences had no statistical significance among 4 groups of sheer surgery, chemotherapy alone, surgery combined with chemotherapy and surgery combined with chemoradiotherapy（all P〉0.05）.ConclusionThe malignant solid tumors in the digestive tract in children and adolescents have a poor prognosis.The unspecific presentation makes the diagnosis difficult.It is very important to diagnose early and treat as soon as possible by the combination of surgery, chemotherapy and radiotherapy to improve the overall survival rate.