影像学危险因素对儿童腹膜后神经母细胞瘤手术并发症的预测价值研究

Correlational research between image danger risk factor and surgical complications of retroperitoneal neuroblastoma in children

目的探讨影像学危险因素(image defined risk factor,IDRF)与儿童腹膜后神经母细胞瘤手术并发症的相关性及临床意义。方法回顾性分析2016年6月至2017年6月在首都医科大学附属北京儿童医院肿瘤外科行手术切除治疗的腹膜后神经母细胞瘤患儿的临床及影像学资料。采用国际神经母细胞瘤危险度分级协作组(international neuroblastoma risk group,INRG)标准定义IDRF。采用Spearman相关分析肿瘤手术前IDRF数目与并发症项数的相关性。采用ROC曲线分析IDRF数目对神经母细胞瘤手术并发症的预测价值。结果本研究共收集神经母细胞瘤患儿68例,其中男童32例,女童36例,发病年龄0~148个月,中位年龄33个月。所有患儿术前评估IDRF共194项,范围为0~11项,中位数为2项,最常见的IDRF为肿瘤包绕腹主动脉和(或)下腔静脉(32/193);39例存在不同类型的并发症,发生并发症共计76项,各例发生并发症0~4项,中位数为1项,最常见的手术并发症为术后电解质紊乱(21/76)。各例患儿手术并发症项数与其肿瘤IDRF数目相关(r=0.713,P<0.05);IDRF数目与各例直接并发症发生项数相关(r=0.700,P<0.05);与各例间接并发症发生项数相关(r=0.420,P<0.05)。术前IDRF数目预测神经母细胞瘤术后并发症的ROC曲线下面积为0.894(95%CI 0.813~0.975)。IDRF数目的临界值为2项,灵敏度85.4%,特异度85.2%,阳性预测值89.7%,阴性预测值79.3%。结论IDRF与手术并发症的发生有重要的相关性,对于手术治疗具有风险评估价值。

Objective To explore the correlation and clinical significance of image defined risk factor(IDRF)with operative complications in children undergoing retroperitoneal neuroblastoma resection.Methods From June 2016 to June 2017,the clinical and imaging data were retrospectively analyzed for 68 children with retroperitoneal neuroblastoma undergoing surgical resection.IDRF was defined according to the standard of International Neuroblastoma Risk Group(INRG).The correlation between the numbers of preoperative IDRF and surgical complications was analyzed by Spearman s correlation coefficient method.The ROC curve was plotted for analyzing the predictive value of the number of IDRFs for surgical complications.Results There were 32 boys and 36 girls with a median onset age of 33(0-148)months.The median number of preoperative IDRFs was 2(0-11).A total of 76 complications occurred in 39 children with a median number of 1(0-4)complication.Postoperative electrolyte disturbance was the most common complication(21/76).The number of operative complications was significantly correlated with the number of IDRF in each patient(r=0.713,P<0.05).And the number of IDRF was correlated with all direct operative complications(r=0.700,P<0.05)and all indirect operative complications(r=0.420,P<0.05).The area under curve in ROC was 0.894(95%CI 0.813-0.975).The number of IDRF had a cut-off value of 2.And the values of sensitivity,specificity,positive predication and negative predication were 85.4%,85.2%,89.7%and 79.3%respectively.Conclusion IDRF is valuable for assessing surgical outcomes due to its important correlation with the occurrence of operative complications.