儿童原发性恶性颅外生殖细胞肿瘤复发的风险因素分析

Risk factors analysis of recurrence in pediatric primary malignant extracranial germ cell tumour

目的探讨儿童原发性恶性颅外生殖细胞肿瘤(MGCT)复发的危险因素。方法回顾性分析2010年1月—2019年12月郑州大学第一附属医院诊断并治疗MGCT患儿的临床资料,使用Logistic回归法分析其复发的高危因素;使用Kaplan-Meier法统计其总生存率(OS)、无事件生存率(EFS)。结果共109例MGCT患儿,5年的OS率、EFS率分别为(91.3±2.8)%、(86.5±3.4)%;复发率为12.8%,主要的复发部位为骶尾部(9/14)。复发组与未复发组相比,在发病部位(χ^(2)=18.45,P<0.01)、COG分期(χ^(2)=11.32,P<0.01)、是否转移(χ^(2)=12.80,P<0.01)、肝转移(χ^(2)=15.29,P<0.01)和肺转移(χ^(2)=9.57,P<0.001)等方面存在差异。Logistic回归分析示骶尾部为其复发的独立危险因素;复发组的OS(59.1±1.4)%低于未复发组(95.7±2.1)%;未完整切除肿瘤组的OS(65.8±1.4)%低于完整切除组(94.5±2.4)%,差异均有统计学意义。结论复发、未完整切除肿瘤的MGCT患儿预后差,骶尾部为MGCT患儿复发的独立危险因素。

Objective To explore the risk factors for recurrence in pediatric primary malignant extracranial germ cell tumor(MGCT).Methods A retrospective analysis was conducted on clinical data of pediatric patients diagnosed and treated for MGCT from January 2010 to December 2019.Logistic regression analysis was used to identify high-risk factors for recurrence in MGCT patients.Kaplan-Meier analysis was performed to compare the overall survival(OS)and event-free survival(EFS)rates among different factors.Results A total of 109 pediatric patients with MGCT were included.The 5-year OS and EFS rates were(91.3±2.8)%and(86.5±3.4)%,respectively.The recurrence rate was 12.8%,the sacrococcygeal region being the main site of recurrence(9/14).There were significant differences between the recurrence group and the non-recurrence group in terms of the primary site(χ^(2)=18.45,P<0.01),COG stage(χ^(2)=11.32,P<0.01),metastasis status(χ^(2)=12.80,P<0.01),liver metastasis(χ^(2)=15.29,P<0.01),and lung metastasis(χ^(2)=9.57,P<0.001).Logistic regression analysis revealed that the sacrococcygeal region was an independent risk factor for recurrence.The OS rate in the recurrence group(59.1±1.4)%was lower than that in the non-recurrence group(95.7±2.1)%,and the OS rate in the incomplete resection group(65.8±1.4)%was lower than that in the complete resection group(94.5±2.4)%,with both differences being statistically significant.Conclusions Patients with recurrent MGCT or incomplete tumor resection have a poor prognosis,and the sacrococcygeal region is an independent risk factor for recurrence in MGCT patients.