顺铂和卡铂为主的化疗方案治疗儿童颅外恶性生殖细胞肿瘤的疗效和安全性比较

Comparison of efficacy and safety between cisplatin-based and carboplatin-based chemotherapy in the treatment of children with extracranial malignant germ cell tumor

目的:比较以顺铂和卡铂为主的化疗方案治疗儿童颅外恶性生殖细胞肿瘤(MGCT)的临床效果,探讨其疗效及不良反应。方法:回顾性分析2014年1月至2020年12月我院血液肿瘤科收治的儿童颅外MGCT患者的临床资料。比较两组患者一般资料、2年总生存率(OS)、2年无事件生存率(EFS)、复发率、肺部感染、肝脏毒性、肾脏毒性、心脏毒性发生率、化疗疗程、化疗后骨髓抑制次数及住院时间等情况。结果:本组共67例患者,以顺铂为主的化疗方案(顺铂组)治疗45例,以卡铂为主的化疗方案(卡铂组)治疗22例。中位随访时间:顺铂组60(31~85)月,卡铂组19.5(8~41)月。两组方案治疗后,顺铂组和卡铂组的2年OS为100%和95.5%(P=0.278),2年EFS为95.6%和90.4%(P=0.527),复发率为6.7%和9.1%(P=0.534),肺部感染发生率为57.8%和27.3%(P=0.019)。IV级化疗后骨髓抑制、肝脏毒性、肾脏毒性、心脏毒性发生率和治疗疗程比较差异无统计学意义。化疗后骨髓抑制伴感染入院治疗为23.3%和12.7%(P=0.013),但感染住院时间比较差异无统计学意义。不同危险度分组复发率及IV级化疗后骨髓抑制发生率比较差异无统计学意义。结论:以卡铂为主的化疗方案在维持儿童颅外MGCT疗效的同时,可以减少肺部感染发生概率及因化疗后骨髓抑制后发生感染的住院率。

Objective:To analyze the efficacy and adverse reaction of children with extracranial malignant germ cell tumor(MGCT)treated with either cisplatin-based or carboplatin-based chemotherapy.Methods:We reviewed clinical data of children with extracranial MGCT initially treated in department of hematology and oncology of our hospital from January 2014 to December 2020.The general data,2-year overall survival(OS),2-year event-free survival(EFS),relapse rate,the incidence of pulmonary infection,hepatic toxicity,renal toxicity and cardiac toxicity,duration of chemotherapy,number of myelosuppression after chemotherapy,and length of hospital stay were compared between the two groups.Results:In 67 patients,45 cases were treated with cisplatin-based chemotherapy(cisplatin group)and 22 cases were treated with carboplatin-based chemotherapy(carboplatin group).The median follow-up time was 60 months(range from 31 to 85 months)in cisplatin group and 19.5 months(range from 8 to 41 months)in carboplatin group.In cisplatin group and carboplatin group,two-year OS was 100%and 95.5%(P=0.278),two-year EFS with 95.6%and 90.4%(P=0.527),the relapse rate with 6.7%and 9.1%(P=0.534).The incidence of pneumonia was 57.8%and 27.3%(P=0.019).There was no significant difference in the incidence of myelosuppression,hepatotoxicity,nephrotoxicity,cardiotoxicity and treatment course.Hospitalization rate ralated to myelosuppression with infection after chemotherapy was 23.3%and 12.7%(P=0.013)respectively,but there was no significant difference in hospital stays.No significant difference was observed in relapse rate and grade IV myelosuppression rate after chemotherapy between different risk groups.Conclusion:While obtaining a positive effect of extracranial MGCT in children,carboplatin-based chemotherapy can reduce the probability of pneumonia and hospitalization rate of infection due to myelosuppression after chemotherapy.