91例儿童髓母细胞瘤术后放射治疗的临床预后及相关因素分析

Clinical prognosis and related factors of 91 children with medulloblastoma after postoperative radiotherapy

目的:探讨儿童髓母细胞瘤(medulloblastoma, MB)的术后放疗效果,分析影响其预后的相关因素。方法:回顾性分析2011年01月至2015年12月我院收治的91例儿童MB病历资料。对性别、年龄、肿瘤部位、手术切除程度、放疗前肿瘤M分期、危险度分组、放疗剂量、靶区范围、术后是否化疗、放疗与手术的时间间隔进行分析。采用Kaplan-Meier法进行生存分析,Log-rank检验进行单因素分析,采用Cox回归模型进行多因素分析。结果:本组患儿9例失访,失访率9.9%,其余82例随访满5年或死亡。随访期间,25例患儿出现局部复发或转移,经治疗后仍有16例死亡,9例带瘤生存,本组患儿3年、5年无进展生存率(progression-free survival, PFS)分别为79.3%、70.8%,3年、5年总生存率(overall survival, OS)分别为84.9%、81.3%。63例标危组的5年PFS和OS为77.5%、89.6%,其中11例行低剂量全中枢放疗的5年OS为76.2%。单因素分析显示,手术切除程度、放疗前肿瘤M分期、危险度分组对PFS(P=0.015,P=0.004,P=0.016)和OS(P=0.009,P=0.001,P=0.002)的影响,差异均有统计学意义。Cox多因素回归分析显示,放疗前肿瘤M分期是影响PFS(P=0.007)及OS(P=0.002)的独立危险因素。结论:手术切除程度、放疗前肿瘤M分期、危险度分组是儿童MB预后差的高危因素,放疗前肿瘤M分期是预后差的独立危险因素。在保证疗效的前提下,降低放疗剂量和靶区范围是研究的重点。

Objective:To evaluate the clinical prognosis and related factors of children medulloblastoma(MB)after postoperative radiotherapy.Methods:91 children with MB treated in our hospital from January 2011 to December 2015 were analyzed retrospectively.Gender, age, tumor location, degree of surgical resection, M stage before radiotherapy, risk-grouping, dose of radiotherapy, radiotherapy target, postoperative chemotherapy or not, and radiotherapy-surgery interval were analyzed.Kaplan-Meier method was used for survival analysis, log rank test was used for univariate analysis, and Cox regression model was used for multivariate analysis.Results:In this group, 9 patients were lost and the loss rate was 9.9%,the other 82 patients were followed up for 5 years or died.During the follow-up periods, 25 patients had local recurrence or metastasis, of which 16 patients died after treatment, 9 patients survived with tumor.The 3,5-year progression free survival(PFS) rates were 79.3%,70.8%and the 3,5-year overall survival(OS) rates were 84.9%,81.3% respectively.The 5-year PFS and OS of 63 patients in the average-risk group were 77.5% and 89.6%,of which 11 patients were treated with reduced-dose craniospinal irradiation, and the 5-year OS was 76.2%.On univariate analysis, the degree of surgical resection, M stage and risk-grouping affected PFS(P=0.015,P=0.004,P=0.016) and OS(P=0.009,P=0.001,P=0.002),with significantly differences.Cox regression multivariate analysis showed that M stage was an independent prognostic factor affecting PFS(P=0.007) and OS(P=0.002).Conclusion:The degree of surgical resection, M stage before radiotherapy and risk-grouping were high risk factors for poor prognosis in children with MB and M stage was an independent prognostic factor for poor prognosis.Reducing dose and volume of radiotherapy without compromising the prognosis is the focus in this field.