CAJ | 학술논문

目的：评价中国儿童神经母细胞瘤协作组09方案(NB09方案)治疗高危和极高危神经母细胞瘤的初步疗效。方法回顾性分析2009年1月—2013年1月天津医科大学肿瘤医院收治的高危和极高危神经母细胞瘤患儿的临床及随访资料。38例患儿纳入分析，其中男27例，女11例。高危组7例，极高危组31例。诊断时月龄19～160个月(中位就诊月龄36.5个月)。高危组：术前新辅助化疗A、B方案交替4～6周期后评估、手术。极高危组手术前后化疗，然后自体干细胞移植，瘤床放疗，停化疗后维甲酸治疗同高危组。结果治疗结束时CR 25例，PR 5例， SD 3例，PD 5例，其中死亡2例，治疗总有效率(CR+PR+SD)86.8%。至随访结束，全组无瘤生存15例，带瘤生存9例，死于肿瘤复发7例，死于进展7例，生存期6～52个月(中位生存期25.5个月)，其1、2、3年总生存率(OS)分别为91.7%、64.5%和57.3%。Kaplan-Meier生存曲线和Log-rank检验提示高危组与极高危组之间生存率差异无统计学意义(P=0.56)。结论 NB09方案治疗高危和极高危神经母细胞瘤的近期疗效初步肯定，值得进一步临床验证。
목적：평개중국인동신경모세포류협작조09방안(NB09방안)치료고위화겁고위신경모세포류적초보료효。방법회고성분석2009년1월—2013년1월천진의과대학종류의원수치적고위화겁고위신경모세포류환인적림상급수방자료。38례환인납입분석，기중남27례，녀11례。고위조7례，겁고위조31례。진단시월령19～160개월(중위취진월령36.5개월)。고위조：술전신보조화료A、B방안교체4～6주기후평고、수술。겁고위조수술전후화료，연후자체간세포이식，류상방료，정화료후유갑산치료동고위조。결과치료결속시CR 25례，PR 5례， SD 3례，PD 5례，기중사망2례，치료총유효솔(CR+PR+SD)86.8%。지수방결속，전조무류생존15례，대류생존9례，사우종류복발7례，사우진전7례，생존기6～52개월(중위생존기25.5개월)，기1、2、3년총생존솔(OS)분별위91.7%、64.5%화57.3%。Kaplan-Meier생존곡선화Log-rank검험제시고위조여겁고위조지간생존솔차이무통계학의의(P=0.56)。결론 NB09방안치료고위화겁고위신경모세포류적근기료효초보긍정，치득진일보림상험증。
Objective To evaluate the clinical outcome of NB09 (China Pediatric Neuroblastoma cooperative group 09) protocol on children with high-risk and ultra-high risk neuroblastoma. Methods The clinical and follow-up data of pa?tients who suffered from high-risk (n=7) and ultra-high risk (n=31) neuroblastomas and admitted in Tumor hospital of Tian?jin Medical University between January 2009 to January 2013 were retrospectively reviewed (27 boys and 11 girls). The age at diagnosis was 19-160 months (median age was 36.5 months). In the high risk group, patients were evaluated and operated after 4 to 6 circles of neoadjuvant chemotherapy. In ultra-high risk group, patient received chemotherapy before and after op?eration, then autologous stem cell transplantation and tumor bed radiotherapy. After chemotherapy, retinoic acid treatment was given to patients in ultra high risk group as in high risk group. Results At the end of treatment, 25 patients achieved complete remission; 5 patients achieved partial remission; 3 patients were in stable disease;5 patients were deteriorating in their conditions which lead to 2 deaths. In total, the response rate reaches upto 86.8%. By the end of follow up, 15 patients had a disease-free-survival, 9 patients survived with tumor, 7 died from recurrence and 7 died from deteriorating conditions. Survival time ranged from 6 to 52 months (median survival 25.5 months). The 1-, 2- and 3-year overall survival were 91.7%, 64.5%and 57.3%respectively. Kaplan-Meier curve and Log-rank test showed no statistical significance between high risk and ultra-high risk neuroblastomas. Conclusion The outcome of NB09 protocol for high risk and ultra-high risk neuroblastoma was preliminary affirmed. It is worthy of further clinical verification.