22例儿童肝母细胞瘤单独肺部复发的临床分析

Clinical analysis for 22 cases of hepatoblastoma with pulmonary recurrence alone

目的总结分析儿童肝母细胞瘤(HB)单独肺部复发的临床特点及预后。方法收集2010年1月—2017年12月在我院治疗的22例单独肺部复发的HB患儿的临床资料,回顾性分析单纯肺部复发HB临床特点及预后。结果经肝脏肿瘤切除术后病理明确诊断为HB且仅肺部复发的22例患者,其中男12例,女10例,中位发病年龄1.36岁,肺部复发中位时间4(2~20)个月。8例初次诊断时无肺部转移,14例初次诊断即伴有肺部转移,均为治疗完全缓解后出现肺部复发。复发后18例患者接受肺部肿瘤切除术:12例行1次肺部手术,6例行2~4次肺部手术。术前给予中位新辅助化疗周期3个,术后中位化疗周期12个,中位总化疗周期15个。本组患者中位随访时间63.5个月,死亡5例,17例完全缓解,5年总生存率为77%。肺部转移瘤切除术组与未切除组的生存时间分别为(102.7±5.2)个月和(16.0±2.3)个月,5年总生存率分别为94%和0%(χ^(2)=19.837,P=0.001)。病理亚型,肺部复发时间及复发病灶数量对预后均无明显影响。结论单独肺部复发HB预后良好,化疗后肺部病灶不能完全缓解者,给予肺部转移瘤切除手术可改善其预后。

Objective To summarize and analyze the clinical features and prognosis for hepatoblastoma(HB)patients with pulmonary recurrence alone.Methods The clinical data of children in HB with pulmonary recurrence alone treated in our hospital from January 2010 to December 2017 were collected,and the clinical and prognostic characteristics were retrospectively analyzed.Results There were 22 patients with pathological diagnosis of HB after liver tumor resection and pulmonary recurrence alone,including 12 boys and 10 girls.The median age of onset was 1.36 years old,and the median time of pulmonary recurrence was 4 months(ranged from 2 to 20 months).8 cases without pulmonary metastasis and 14 cases with pulmonary metastases at the first diagnosis,and all pulmonary recurrence occurred after complete remission.Eighteen patients underwent pulmonary tumor resection.18 cases underwent pulmonary metastasectomy.12 cases underwent once pulmonary metastasectomy,and 6 cases underwent 2-4 times of pulmonary metastasectomy.The median of neoadjuvant chemotherapy cycle was 3,and the median of postoperative chemotherapy cycle was 12,and the median of total chemotherapy cycle was 15.After median follow-up 63.5 months,5 patients died and 17 patients completely remission.The 5-year overall survival rate was 77%.The survival time of pulmonary metastasectomy group and non-pulmonary metastasectomy group were(102.67±5.18)months and(16.00±2.27)months respectively,and the 5-year overall survival rate were 94%and 0%respectively.The log-rank test showed a statistical difference between the two groups(χ^(2)=19.837,P=0.000).The pathological subtype,recurrence time and number of pulmonary metastasis showed no statistical difference for the prognosis.Conclusions HB patients with pulmonary recurrence alone have a good prognosis.If they can′t be completely relieved after chemotherapy,they should be given pulmonary metastasectomy to get better prognosis.