摘要
目的：探讨手术切除范围对晚期神经母细胞瘤患儿预后的影响。方法选择2006年1月至2009年12月我院手术治疗的37例晚期神经母细胞瘤患儿，采用手术或手术＋化疗进行治疗，其中完全切除24例，部分切除13例；随访≥5年，采用 Log-rank 检验和多因素 COX 回归分析手术切除范围对预后的影响。结果完全切除组总体生存期的影响因素包括淋巴转移、临床分期、配合化疗、肿瘤标志物神经元特异性烯醇化酶等（P 值分别为0.002、0.000、0.019、0.015）；COX 回归显示神经母细胞瘤患儿总体生存期的独立影响因素有配合化疗（OR =1.952，95％ CI 为1.258～2.759，P =0.000）、淋巴结转移（OR =2.856，95％ CI 为1.356～3.859，P =0.019）、是否完全切除（OR =3.069，95％ CI 为1.585～4.685， P =0.005）；本组患儿生存时间最短为1个月，中位生存时间33.96个月，1年生存率62.21％，2年生存率41.09％，3年生存率23.59％，完全切除组与部分切除组平均生存时间分别为（56.96±13.22）、（19.63±10.20）个月，经 Log-rank 检验，差异具有统计学意义（P =0.019）。结论手术切除范围是神经母细胞瘤患儿预后的重要影响因素，在患儿自身条件许可的情况下，可以适当扩大手术切除范围，降低肿瘤复发风险。
Objective To investigate the effect of the extent of surgical resection on the prognosis of children patients with advanced neuroblastoma. Methods Thirty-seven children patients with advanced neuroblastoma were selected as our subjects,who underwent surgical treatment in the People＆#39;s Hospital Binzhou from Jan. 2001to Dec. 2006. All the patients were treated with surgical operation or surgical operation combined with chemotherapy,among them 24 cases were completely removal,and 13 cases were partially removal. All patients were followed-up for more than 5 years. Log rank test and multivariate COX regression analysis were used to explore the effect of surgery resection on prognosis. Results The influencing factors of the complete resection group included lymphatic metastasis,clinical stage,combined with chemotherapy,tumor markers neuronspecific enolase（P = 0. 002,0. 000,0. 019,0. 015 respectively）. COX regression analysis showed that the independent factors included chemotherapy（ OR = 1. 952,95% CI = 1. 258 - 2. 759,P = 0. 000）,lymph node metastasis（OR = 2. 856,95% CI = 1. 356 - 3. 859,P = 0. 019）,and extent of surgical resection（OR = 3. 069, 95% CI = 1. 585 - 4. 685,P = 0. 005）. The shortest survival period of patients in this study was a month,and the median survival period was 33. 96 months. One year survival rate was 62. 21% and 2-year survival rate was 41. 09% as well as 3-year survival rate was 23. 59% . The average survival period between total and partial of surgical resection was significant（（56. 96 ± 13. 22）months,（19. 63 ± 10. 20）months;P = 0. 019）. Conclusion Surgical resection is an important factor of the prognosis of patients with NB. If the patient＇s own conditions permit,it can be appropriate to expand the scope of surgical resection in order to reduce the risk of tumor recurrence.
出处
《中国综合临床》
2014年第7期747-750,共4页
Clinical Medicine of China
关键词
神经母细胞瘤
手术切除范围
预后
Advanced neuroblastoma
Surgical resection
Prognosis
作者简介
通信作者：曲修水，Email：quxiushui1965@163．com
