中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
7期
747-750
,共4页
神经母细胞瘤%手术切除范围%预后
神經母細胞瘤%手術切除範圍%預後
신경모세포류%수술절제범위%예후
Advanced neuroblastoma%Surgical resection%Prognosis
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。
目的：探討手術切除範圍對晚期神經母細胞瘤患兒預後的影響。方法選擇2006年1月至2009年12月我院手術治療的37例晚期神經母細胞瘤患兒，採用手術或手術+化療進行治療，其中完全切除24例，部分切除13例；隨訪≥5年，採用 Log-rank 檢驗和多因素 COX 迴歸分析手術切除範圍對預後的影響。結果完全切除組總體生存期的影響因素包括淋巴轉移、臨床分期、配閤化療、腫瘤標誌物神經元特異性烯醇化酶等（P 值分彆為0.002、0.000、0.019、0.015）；COX 迴歸顯示神經母細胞瘤患兒總體生存期的獨立影響因素有配閤化療（OR =1.952，95％ CI 為1.258~2.759，P =0.000）、淋巴結轉移（OR =2.856，95％ CI 為1.356~3.859，P =0.019）、是否完全切除（OR =3.069，95％ CI 為1.585~4.685， P =0.005）；本組患兒生存時間最短為1箇月，中位生存時間33.96箇月，1年生存率62.21％，2年生存率41.09％，3年生存率23.59％，完全切除組與部分切除組平均生存時間分彆為（56.96±13.22）、（19.63±10.20）箇月，經 Log-rank 檢驗，差異具有統計學意義（P =0.019）。結論手術切除範圍是神經母細胞瘤患兒預後的重要影響因素，在患兒自身條件許可的情況下，可以適噹擴大手術切除範圍，降低腫瘤複髮風險。
목적：탐토수술절제범위대만기신경모세포류환인예후적영향。방법선택2006년1월지2009년12월아원수술치료적37례만기신경모세포류환인，채용수술혹수술+화료진행치료，기중완전절제24례，부분절제13례；수방≥5년，채용 Log-rank 검험화다인소 COX 회귀분석수술절제범위대예후적영향。결과완전절제조총체생존기적영향인소포괄림파전이、림상분기、배합화료、종류표지물신경원특이성희순화매등（P 치분별위0.002、0.000、0.019、0.015）；COX 회귀현시신경모세포류환인총체생존기적독립영향인소유배합화료（OR =1.952，95％ CI 위1.258~2.759，P =0.000）、림파결전이（OR =2.856，95％ CI 위1.356~3.859，P =0.019）、시부완전절제（OR =3.069，95％ CI 위1.585~4.685， P =0.005）；본조환인생존시간최단위1개월，중위생존시간33.96개월，1년생존솔62.21％，2년생존솔41.09％，3년생존솔23.59％，완전절제조여부분절제조평균생존시간분별위（56.96±13.22）、（19.63±10.20）개월，경 Log-rank 검험，차이구유통계학의의（P =0.019）。결론수술절제범위시신경모세포류환인예후적중요영향인소，재환인자신조건허가적정황하，가이괄당확대수술절제범위，강저종류복발풍험。
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'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.
