儿童髓母细胞瘤的个体化治疗及预后相关因素分析

Individualized treatment of medulloblastoma in children and analysis of prognostic factors

目的探索儿童髓母细胞瘤(MDB)的风险分级和分层治疗对预后的影响。方法回顾性分析自2011年1月至2019年12月由笔者行经小脑延髓裂入路显微手术治疗的32例MDB患儿的临床资料。根据风险分层标准,将MDB分为低危、中危和高危组,分析治疗模式、风险分级与预后的关系。结果本组MDB患儿中肿瘤全切除和近全切除29例,全切除和近全切除率为90.6%,次全切除3例,无手术相关死亡病例,无永久性脑脊液漏。随访时间6~84个月,32例MDB患儿的3年总生存率(OS)为96.9%,5年OS为84.4%。低危组3年、5年OS明显优于高危组,中危组5年OS为91.7%,高危组5年OS仅63.6%。手术后联合化学治疗(ChT)+放射治疗(RT)的综合治疗模式的患儿5年OS为95.5%,单纯手术治疗的效果最差,患儿3年OS仅66.7%(2/3)。结论根据MDB的危险分级制定个体化的治疗方案,有利于提高MDB治疗的生存率和改善生存质量。术后联合ChT+RT对改善MDB预后有重要意义。

Objective To explore the impact of risk grading and stratified treatment of children with medulloblastoma(MDB)on the prognosis.Methods A retrospective analysis of the clinical data of 32 children with MDB treated by microsurgery through the cerebellar medulla oblongata approach admitted by the author from January 2011 to December 2019 was retrospectively analyzed.According to risk stratification criteria,MDB was divided into low-risk,intermediate-risk and high-risk groups,and the relationship between treatment mode,risk classification and prognosis was analyzed.Results There were 29 cases of total resection and near total resection,and the rate of total resection and near total resection was 90.6%;3 cases were subtotal resection.There were no deaths related to surgery and no permanent cerebrospinal fluid leakage.The follow-up time was 6-84 months,the 3-year overall survival(OS)rate was 96.9%,and the 5-year OS rate was 84.4%.The 3-year and 5-year OS rate of the low-risk group was significantly better than that of the high-risk group.The 5-year OS rate of the intermediate-risk group was 91.7%,and the 5-year OS rate of the high-risk group was only 63.6%.The combined 5-year OS rate of combined chemotherapy(ChT)and radiotherapy RT after surgery was 95.5%,and surgery alone had the worst effect,with a 3-year OS rate of only 66.7%.Conclusion According to the risk classification of MDB,an individualized treatment plan is helpful to increase the survival rate of MDB treatment and improve the quality of life.Combining RT and ChT after surgery is of great significance to improve the prognosis.