CAJ | 학술논문

目的比较分析儿童与成人横纹肌肉瘤的预后差别及其临床影响因素.方法回顾性分析天津医科大学肿瘤医院1993年1月至2009年6月间经病理确诊为横纹肌肉瘤且有完整随访资料的184例患者,其中分为儿童组93例(≤18周岁)和成人组91例(＞18周岁).结果 1年、3年、5年生存率儿童组分别为90.3％、62.0％、43.1％,成人组分别为86.8％、35.1％、20.0％.两组间1年生存率差异无统计学意义(P=0.454),但3年(P=0.001)和5年(P=0.007)生存率成人组均低于儿童组,并且Kaplan-Meier生存曲线也提示成人组(中位生存期26.7个月)低于儿童组(中位生存期47.3个月),Log-rank检验两生存曲线差异有统计学意义(P=0.003).多因素分析显示组织学类型、原发部位和术后分组是儿童RMS预后的独立影响因素,组织学类型、原发肿瘤大小和术后分组是成人RMS预后的独立影响因素.x2检验显示儿童组与成人组在组织学类型(胚胎型:77.4％、27.5％；腺泡或多形性:22.6％、72.5％；P=0.000)、原发部位(预后好的部位:40.9％、22.0％；预后不好部位:59.1％、78.0％;P=0.006)和远处转移(无转移:87.1％、73.6％；有转移:12.9％、26.4％；P=0.021)因素的差异具有统计学意义.结论成人RMS的预后明显差于儿童,组织学类型、原发部位和远处转移的差异是导致这种差别的可能因素.
목적 비교분석인동여성인횡문기육류적예후차별급기림상영향인소.방법 회고성분석천진의과대학종류의원1993년1월지2009년6월간경병리학진위횡문기육류차유완정수방자료적184례환자,기중분위인동조93례(≤18주세)화성인조91례(＞18주세).결과 1년、3년、5년생존솔인동조분별위90.3％、62.0％、43.1％,성인조분별위86.8％、35.1％、20.0％.량조간1년생존솔차이무통계학의의(P=0.454),단3년(P=0.001)화5년(P=0.007)생존솔성인조균저우인동조,병차Kaplan-Meier생존곡선야제시성인조(중위생존기26.7개월)저우인동조(중위생존기47.3개월),Log-rank검험량생존곡선차이유통계학의의(P=0.003).다인소분석현시조직학류형、원발부위화술후분조시인동RMS예후적독립영향인소,조직학류형、원발종류대소화술후분조시성인RMS예후적독립영향인소.x2검험현시인동조여성인조재조직학류형(배태형:77.4％、27.5％；선포혹다형성:22.6％、72.5％；P=0.000)、원발부위(예후호적부위:40.9％、22.0％；예후불호부위:59.1％、78.0％;P=0.006)화원처전이(무전이:87.1％、73.6％；유전이:12.9％、26.4％；P=0.021)인소적차이구유통계학의의.결론 성인RMS적예후명현차우인동,조직학류형、원발부위화원처전이적차이시도치저충차별적가능인소.
Objective To compare the prognostic factors and clinical differences between pediatric and adult rhabdomyosarcoma.Methods We reviewed the clinical data of 184 patients who were diagnosed to have RMS by pathology and had complete follow-up data between January 1993 and June 2009 in the Cancer Institute and Hospital of Tianjin Medical University.There were 93 pediatric patients (age≤18 years) and 91 adult patients (age＞18 years).Results The 1-,3-and 5-year survival rates in the pediatric group were 90.3％,62.0％,43.1％,respectively,while these were 86.8％,35.1％,20.0％,respectively in the adult group.No significant statistical difference was seen in the 1-year survival rates (P =0.454) between the two groups.However the adult group had significantly lower 3-year (P =0.001 ) and 5-year (P =0.007) survival rates.Kaplan-Meier curve also showed that the adult group ( Median survival 26.7 months) had a lower survival rate than the pediatric group (Median survival 47.3 months,Log-rank test P =0.003).Multivariate analysis showed that the histological subtypes,primary site and post-surgical stratification were independent prognostic factors for pediatric RMS,while the histological subtypes,tumor size and post-surgical stratification were responsible for adult RMS prognosis.Significant statistical differences were showed between the pediatric group and adult group in the factors of histological subtypes(Embryonal:77.4 ％ vs 27.5 ％ ; Alveolar or Pleomorphic:22.6％ vs 72.5％ ;P =0.000),primary site(Favorable site:40.9％ vs 22.0％ ; Unfavorable site:59.1％ vs 78.0 ％ ; P =0.006) and distant metastasis(No metastasis:87.1 ％ vs 73.6 ％％ ;Metastasis:12.9％ vs 26.4％ ; P =0.021 ) by Chi-square Test.Conclusions The prognosis of adult RMS is significantly worse than pediatric tumor,and the differences of the histological subtypes,primary site and distant metastases between the two groups should be responsible for it.