儿童肝母细胞瘤治疗影像评估

Image Evaluation of the Treatment of Hepatoblastoma in Children

目的:回顾性分析肝母细胞瘤患儿一般临床病理特点、治疗前后影像学特征变化及疗效评估,总结肝母细胞瘤治疗效果、分析并探索影响预后的因素。方法:回顾分析68例具有术前各期影像学资料、经手术治疗及病理证实并能随访的肝母细胞瘤患者,并对预后因素进行了分析。结果:68例肝母细胞瘤患儿中,男女比例约1.43:1,<5岁患者达83.8%,新辅助化疗病人中90%肿瘤体积减小,75%病灶内坏死、囊变区域扩大,70%钙化增多;术前术后分期符合率可以达到86.7%。18例患者在术后治疗中或随访中出现复发、转移灶反复或新发转移灶。初诊时存在高危因素的20例患者中,术后其中65%患者预后差,初诊未有高危表现的患者中5例在随访中出现转移或复发,含有胚胎成分预后较差。结论:高危因素对预后判断影响大,新辅助化疗可以获得肿瘤降期效果,通过影像学检査,可以对肝母细胞瘤进行分期,确定高危因素,对疗效评估起重要作用。

Purpose:To retrospectively analyze the differences of the clinicopathological characteristics,the changes of imaging features and the evaluation of curative effect in children with hepatoblastoma before and after treatment,and to summarize the therapeutic effect of hepatoblastoma,explore the factors affecting prognosis.Methods:Retrospective follow-up studies were conducted on 68 cases of hepatoblastoma confirmed by pathology results.All their imaging data and the prognostic factors were analyzed.Results:In children with hepatoblastoma,the ratio of male to female was 1.43:1,83.8%cases were under 5 years of age.Of all the patients who received neoadjuvant chemotherapy,the size of the tumors were reduced in 90%,the necrosis or cystic areas were enlarged in 75%,the calcification areas were increased in 70%.The accuracy between PRETEXT/POSTTEXT stages and pathological grades reached 86.7%.Eighteen cases were with recurrence or new metastasis during post-operative treatment or follow-up.Of the 20 patients with high-risk factors,65%were with poor prognosis.Five patients with no high-risk factors were with recurrence or new metastasis,while those who with embryonic components were with poor prognosis.Conclusion:High-risk factors are with great influence on prognosis.Neoadjuvant chemotherapy can descend the stage.Learning from the imaging features,the stage and high-risk factors can be determined,which also plays an important role in the evaluation of clinical treatment.