儿童Ⅲ/Ⅳ期神经母细胞瘤的综合治疗及生存分析

Comprehensive treatment and survival analysis of stage Ⅲ/Ⅳ neuroblastoma in children

目的总结单中心15年间诊治的Ⅲ/Ⅳ期神经母细胞瘤(neuroblastoma,NB)患儿病例,为改进晚期NB患儿治疗方法提供临床建议。方法回顾性分析解放军总医院一中心儿科2001年1月1日-2015年12月31日收治的76例神经母细胞瘤Ⅲ期、Ⅳ期患儿临床资料、治疗方法,随访长期生存情况,统计生存率及预后影响因素。结果76例患儿中女36例(47.7%),男40例(52.6%)。年龄≤1岁4例(5.3%),1~5岁49例(64.5%),≥5岁23例(30.2%)。其中神经母细胞瘤Ⅲ期17例(22.4%),Ⅳ期59例(77.6%)。76例均行化疗,手术61例(80.3%),放疗19例(25.0%),造血干细胞移植和生物治疗40例(52.6%)。总体平均生存时间为(72.2±8.9)个月,中位生存时间为34.0个月,总体1年生存率为78.0%,2年生存率为60.5%,5年生存率为36.9%。接受手术者生存时间长于未手术者(38.0个月vs 10.0个月,P<0.001);接受干细胞移植和生物治疗者生存时间长于未接受者(138.0个月vs 17.0个月,P<0.001)。分期(Ⅲ期/Ⅳ期)、放疗与否对患儿的总生存率无显著影响(P>0.05)。结论手术、干细胞移植和生物治疗可延长晚期NB患儿的生存期。

Objective To summarize the clinical data about children with stage Ⅲ/Ⅳ neuroblastoma(NB)in a single center for 15 years,so as to provide suggestions for improving the treatment of advanced NB in children.Methods Seventy-six stage Ⅲ or ⅣNB children treated in our department from January 1,2001 to December 31,2015 were selected as the subjects.The clinical data and treatment regimen were retrospectively analyzed.Long-term survival was followed up and prognostic factors were explored.Results Of the 76 cases,36 cases were female(47.7%)and 40 cases were male(52.6%).Four cases(5.3%)were younger than 1 year,49 cases(64.5%)were 1-5 years and 23 cases(30.2%)were older than 5 years.Seventeen cases(22.4%)were in stage Ⅲ and59 cases(77.6%)in stage Ⅳ.Chemotherapy was administered to all cases,61 children(80.3%)underwent surgery and 19 children(25.0%)accepted radiotherapy.Forty(52.6%)cases underwent hematopoietic stem cell transplantation and biotherapy.The average survival time of all NB children was 72.2±8.9 months and the median survival time was 34.0 months.The overall one-year survival rate was 78.0%,the two-year survival rate was 60.5%,and the five-year survival rate was 36.9%.The survival time of patients undergoing surgery was longer than that of patients without surgery(38.0 months vs 10.0 months,P<0.001).The survival time of children who received stem cell transplantation and biotherapy was longer than those without stem cell transplantation and biotherapy(138.0 months vs 17.0 months,P<0.001).Conclusion Surgery,stem cell transplantation and biotherapy can prolong the survival of children with advanced NB.