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目的分析影响儿童神经母细胞瘤(NB)的临床预后因素,期望通过综合性诊断治疗方案改善NB的预后。方法研究对象为1998年10月至2003年12月新诊断为NB患儿,根据年龄及分期分为高、中、低危3组,各组采用包括不同化疗强度的NB综合治疗方案。方案包括确切分期分组,Ⅲ、Ⅳ期患儿延迟或二次肿瘤根治术,不同强度的化疗方案和完成化疗后全顺维甲酸诱导分化治疗,高危组在化疗结束时接受自身造血干细胞移植(ASCT)。结果年龄6个月至11岁,共45例。Ⅰ期9例,Ⅱ期1例,Ⅲ期8例,Ⅳ期26例,Ⅳs期1例。6例在≤2个疗程后好转中放弃治疗;39例按计划治疗,11例接受了ASCT。获得完全缓解(CR)31例(80%),获得部分缓解(PR)8例(20%)。中位随访期21个月(14个月至64个月);末次随访时CR24例(62%),中位CR时间为22个月;带病生存病情稳定4例,总生存率(SR)72%。疾病进展、复发或已死亡11例(28%)。大于18个月、Ⅲ期及Ⅳ期明显影响预后,P分别为0.04、0.003。不同危险组预后不同,P为0.003。肿瘤原发于后腹膜.Ⅲ、Ⅳ期患儿手术未能完全切除肿瘤和未能接受ASCT者预后差,但未达统计学有效水平,P=0.092、0.55和0.60。结论NB综合整体治疗方案较为合理。年龄大于18个月、Ⅲ期及Ⅳ期为预后不良因素。肿瘤原发于后腹膜、手术未能完全切除肿瘤和未能接受ASCT预后差,但P未达统计学有效水平。
Objective To analyze the clinical prognostic factors affecting children with neuroblastoma (NB), and to improve the prognosis of NB by comprehensive diagnosis and treatment. Methods The subjects were newly diagnosed as NB from October 1998 to December 2003. The patients were divided into high, medium and low risk groups according to their age and stage. NB combined treatment regimens with different chemotherapeutic strengths were used in each group. The program included the exact staging group, delayed or secondary tumor radical surgery in children with stage III and IV disease, chemotherapy regimens of different intensities and induction chemotherapy with cisplatin-induced differentiation after chemotherapy. The high-risk group underwent ASCT (hematopoietic stem cell transplantation) . Results The age of 6 months to 11 years old, a total of 45 cases. 9 cases of stage Ⅰ, 1 case of stage Ⅱ, 8 cases of stage Ⅲ, 26 cases of stage Ⅳ and 1 case of stage Ⅳs. Six patients discontinued treatment after ≤2 courses of improvement; 39 were scheduled and 11 received ASCT. Thirty-one patients (80%) had complete remission (CR) and 8 patients (20%) had partial remission (PR). The median follow-up period was 21 months (range, 14 months to 64 months). At the last follow-up, 24 (62%) CR had a median CR of 22 months. Stable disease survived in 4 cases and overall survival (SR) 72%. Eleven patients (28%) had disease progression, relapse, or had died. More than 18 months, Ⅲ and Ⅳ significantly affect the prognosis, P were 0.04,0.003. Different risk groups have different prognosis, P is 0.003. The tumors were found in the posterior peritoneum, and the patients with stage Ⅲ and Ⅳ had incomplete resection of the tumor and the poor prognosis of those who failed to receive ASCT, but the results were not statistically significant (P = 0.092, 0.55 and 0.60). Conclusion NB comprehensive overall treatment plan is more reasonable. Age greater than 18 months, Ⅲ and Ⅳ poor prognosis factors. Tumor origin in the retroperitoneum, surgery failed to completely remove the tumor and did not receive ASCT poor prognosis, but P was less than the statistically significant level.