术前TACE对提高儿童肝母细胞瘤长期生存率的影响

Effect of preoperative TACE on improving long-term survival in children with hepatoblastoma

目的观察并分析术前经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)对提高儿童肝母细胞瘤(hepatoblastoma,HB)长期生存率的影响。方法回顾性分析2013年5月至2021年6月华中科技大学同济医学院附属武汉儿童医院收治的13例HB患儿的临床资料,其中PRETEXT分期Ⅳ期3例,Ⅲ期4例,Ⅱ期6例。患儿在初次诊断为HB后先行TACE+全身化疗,待瘤体缩小并符合外科切除条件后再行外科手术。观察术后1、2、3及5年生存率。结果所有患儿均成功行TACE及手术切除,随访至今:1年13例,2年12例,3年11例,5年4例,8年6个月1例。PRETEXT分期Ⅱ期2年生存率100%(6/6),Ⅲ~Ⅳ期患儿2年生存率100%(6/6);综合生存率:术后1年生存率(100%,13/13)、2年生存率(100%,12/12)、3年生存率(100%,11/11),与广州市妇女儿童医疗中心胡超等2021年报道的50例HB患儿采取化疗联合手术切除术后PRETEXI-Ⅱ期患儿的2年生存率为90.91%,Ⅲ~Ⅳ期患儿的2年生存率为64.29%比较,生存率明显提高,差异有统计学意义(P<0.05)。结论术前行TACE可明显提高儿童HB患儿长期生存率,且安全性较高,值得临床广泛应用。

Objective To observe and analyze the preoperative TACE in improving long-term survival rate of children with hepatoblastoma(HB).Methods The clinical data of 13 children with HB admitted to our hospital from May 2013 to June 2021 were retrospectively analyzed.There were 3 patients with stageⅣ,4 patients with stageⅢand 6 patients with stageⅡin the pretext stage.After the initial diagnosis of Hb,tace+systemic chemotherapy was performed first,and then surgery was performed after the tumor was reduced and met the conditions for surgical resection.The 1-year,2-year,3-year and 5-year survival rates were observed.Results TACE and surgical resection were successfully performed in all patients.Follow-up according to TACE treatment time:13 cases in 1 year,12 cases in 2 years,11 cases in 3 years,4 cases in 5 years,and 1 case in 8 years and 6 months.The 2-year survival rate of patients with pretext stageⅡwas 100%(6/6),and the 2-year survival rate of patients with stageⅢ-Ⅳwas 100%(6/6).Comprehensive survival rate:1-year survival rate(100%,13/13),2-year survival rate(100%,12/12),3-year survival rate(100%,11/11).One case has been followed up for 8 years and 6 months.Compared with the two-year survival rate of 50 children with HB after chemotherapy combined with surgical resection reported by Hu Chao et al.of Guangzhou women and children's Medical Center in 2021(the two-year survival rate was 90.91%for stageⅡand 64.29%for stageⅢ-Ⅳ),the survival rate was significantly improved,and the difference was statistically significant(P<0.05).Conclusion Preoperative TACE in the treatment of children with Hb can significantly improve the long-term survival rate,and has high safety,which is worthy of wide clinical application.