初诊手术切除对肝母细胞瘤患者预后的影响

Effect of Initial Surgical Resection on Prognosis of Children with Hepatoblastoma

目的研究肝母细胞瘤危险分层系统CHIC-HS极低危和低危患者接受初诊手术切除能否获得长期的疾病控制。方法选取2009年1月~2017年12月首都儿科研究所附属儿童医院收治的极低危和低危肝母细胞瘤患者47例,其中24例接受初诊手术切除。所有患者术后进行5年以上的随访,并计算化疗铂类药物的总累积剂量,以探索初诊手术切除对患者预后的影响。结果所有患者手术顺利,无术中并发症。23例患者接受2~6个周期的术前新辅助化疗,所有患者均接受2~4个周期的术后辅助化疗。接受初诊手术切除的患者5年无事件生存率(event-free survival,EFS)及5年总生存率(overall survival,OS)与接受新辅助化疗的患者差异无统计学意义(EFS:91.67%vs 86.96%,P=0.590,OS:95.83%vs 95.65%,P=0.988)。接受初诊手术切除的患者铂类药物总累积剂量显著低于接受新辅助化疗的患者(251.3±66.9mg/m^(2) vs 598.7±68.4mg/m^(2)),差异有统计学意义(P<0.001)。结论极低危和低危肝母细胞瘤患者接受初诊手术切除可以实现长期疾病控制,并能明显减少铂类药物的总累积剂量。

Objective Objective To investigate whether long-term disease control can be achieved in very low-risk and low-risk patients with hepatoblastoma(HB)undergoing initial surgical resection.Methods Forty-seven patients with very low-risk and low-risk HB admitted to the Affiliated Children′s Hospital of Capital Institute of Pediatrics from January 2009 to December 2017 were included,of which 24 patients underwent initial surgical resection.All patients were followed up for more than 5 years after surgery,and the cumulative dose of overall chemotherapy platinum drugs was calculated to explore the impact of initial surgical resection on the prognosis of patients.Results Surgeries went uneventfully and there were no surgical complications in all patients.23 patients received 2-6 cycles of preoperative neoadjuvant chemotherapy,and all patients received 2-4 cycles of postoperative adjuvant chemotherapy.There was no statistically significant difference in the 5-year event-free survival(EFS)and 5-year overall survival(OS)between patients who underwent initial surgical resection and those who underwent surgery after neoadjuvant chemotherapy(EFS:91.67%vs 86.96%,P=0.590;OS:95.83%vs 95.65%,P=0.988).The overall cumulative dose of platinum drugs in patients undergoing initial surgical resection was significantly lower than that in patients undergoing surgery after neoadjuvant chemotherapy(251.3±66.9mg/m^(2) vs 598.7±68.4mg/m^(2)),and the difference was statistically significant(P<0.001).Conclusion Initial surgical resection of HB in very low-risk and low-risk patients can achieve long-term disease control and significantly reduce the overall cumulative dose of platinum drugs.