中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
12期
918-922
,共5页
葛军涛%李龙%乔国梁%魏延栋%张震%刘树立%张军%王琛%于蒲
葛軍濤%李龍%喬國樑%魏延棟%張震%劉樹立%張軍%王琛%于蒲
갈군도%리룡%교국량%위연동%장진%류수립%장군%왕침%우포
癌,肝细胞%预后%危险因素
癌,肝細胞%預後%危險因素
암,간세포%예후%위험인소
Carcinoma,Hepatocellular%Prognosis%Risk factors
目的 分析影响肝母细胞瘤患儿综合治疗预后的危险因素.方法 回顾性分析2001年5月1日至2012年1月30日本院收治的136例肝母细胞瘤患儿临床和病理资料及随访112例信息,治疗以手术加化疗为主,化疗分为术前化疗和术后化疗.随访时间35.6(3～144)个月.应用Kaplan-Meier曲线和Log-Rank检验进行生存分析,Cox比例风险回归模型进行单、多因素分析.采用SPSS 19.0软件进行统计学分析.结果 112例患儿中肿瘤中位直径(8.4±3.1)cm (2.9～19.0 cm),AFP中位水平(6 453.8±47 699.2)μg/L(12.9～484 000.0 μg/L),肿瘤PRETEXT Ⅰ、Ⅱ、Ⅲ、Ⅳ分期为3例(2.7％)、16例(14.3％)、42例(37.5％)、51例(45.5％),单发肿瘤96例(85.7％),多发肿瘤16例(14.3％),有远处转移者27例(24.1％),无远处转移者85例(75.9％).肝母细胞瘤患儿血管侵犯者25例,其中门静脉侵犯17例(68％),腔静脉侵犯8例(32％).K-M生存曲线分析显示,影响肝母细胞瘤患儿预后的危险因素包括AFP水平、PRETEXT分期、肿瘤单发多发、有无转移和血管侵犯.患儿血清甲胎蛋白(AFP)＜100 μg/L或＞10 000 μg/L组(61例)5年生存率为47％(28例/61例)较AFP在100～10 000 μg/L组(51例)71.3％(36/51)低;肿瘤多发组(16例)5年生存率为25.9％(4/16)较单发组(96例)68.8％(66/96)低;PRETEXTⅣ期高危组(51例)患儿5年生存率为41.8％(21/51)较PRETEXT Ⅰ、Ⅱ、Ⅲ期标准组(61例)71.7％(44/61)低;有转移组(27例)5年生存率为24.3％(6/27)较无转移组(85例)67.9％(57/85)低;有血管侵犯组(25例)5年生存率为35％(9/25)较无血管侵犯组(87例)64.3％(56/87)低.Cox比例风险回归模型多因素分析显示AFP＜100 μg/L或＞10 000 μg/L(HR 2.454,95％CI 1.207～4.987,P=0.013); PRETEXT Ⅳ期(HR 2.817,95％CI 1.373～5.783,P=0.005);多发肿瘤(HR 2.852,95％CI 1.256～6.475,P=0.012);远处转移(HR 2.654,95％CI 1.342～5.267,P=0.005);血管侵犯(HR 2.272,95％CI1.102～4.687,P=0.026).结论 肝母细胞瘤患儿预后与AFP水平、肿瘤单发多发、PRETEXT分期、有无转移、血管侵犯有关,在不同危险因素存在的情况下,肝母细胞瘤患儿预后会有差异.
目的 分析影響肝母細胞瘤患兒綜閤治療預後的危險因素.方法 迴顧性分析2001年5月1日至2012年1月30日本院收治的136例肝母細胞瘤患兒臨床和病理資料及隨訪112例信息,治療以手術加化療為主,化療分為術前化療和術後化療.隨訪時間35.6(3～144)箇月.應用Kaplan-Meier麯線和Log-Rank檢驗進行生存分析,Cox比例風險迴歸模型進行單、多因素分析.採用SPSS 19.0軟件進行統計學分析.結果 112例患兒中腫瘤中位直徑(8.4±3.1)cm (2.9～19.0 cm),AFP中位水平(6 453.8±47 699.2)μg/L(12.9～484 000.0 μg/L),腫瘤PRETEXT Ⅰ、Ⅱ、Ⅲ、Ⅳ分期為3例(2.7％)、16例(14.3％)、42例(37.5％)、51例(45.5％),單髮腫瘤96例(85.7％),多髮腫瘤16例(14.3％),有遠處轉移者27例(24.1％),無遠處轉移者85例(75.9％).肝母細胞瘤患兒血管侵犯者25例,其中門靜脈侵犯17例(68％),腔靜脈侵犯8例(32％).K-M生存麯線分析顯示,影響肝母細胞瘤患兒預後的危險因素包括AFP水平、PRETEXT分期、腫瘤單髮多髮、有無轉移和血管侵犯.患兒血清甲胎蛋白(AFP)＜100 μg/L或＞10 000 μg/L組(61例)5年生存率為47％(28例/61例)較AFP在100～10 000 μg/L組(51例)71.3％(36/51)低;腫瘤多髮組(16例)5年生存率為25.9％(4/16)較單髮組(96例)68.8％(66/96)低;PRETEXTⅣ期高危組(51例)患兒5年生存率為41.8％(21/51)較PRETEXT Ⅰ、Ⅱ、Ⅲ期標準組(61例)71.7％(44/61)低;有轉移組(27例)5年生存率為24.3％(6/27)較無轉移組(85例)67.9％(57/85)低;有血管侵犯組(25例)5年生存率為35％(9/25)較無血管侵犯組(87例)64.3％(56/87)低.Cox比例風險迴歸模型多因素分析顯示AFP＜100 μg/L或＞10 000 μg/L(HR 2.454,95％CI 1.207～4.987,P=0.013); PRETEXT Ⅳ期(HR 2.817,95％CI 1.373～5.783,P=0.005);多髮腫瘤(HR 2.852,95％CI 1.256～6.475,P=0.012);遠處轉移(HR 2.654,95％CI 1.342～5.267,P=0.005);血管侵犯(HR 2.272,95％CI1.102～4.687,P=0.026).結論 肝母細胞瘤患兒預後與AFP水平、腫瘤單髮多髮、PRETEXT分期、有無轉移、血管侵犯有關,在不同危險因素存在的情況下,肝母細胞瘤患兒預後會有差異.
목적 분석영향간모세포류환인종합치료예후적위험인소.방법 회고성분석2001년5월1일지2012년1월30일본원수치적136례간모세포류환인림상화병리자료급수방112례신식,치료이수술가화료위주,화료분위술전화료화술후화료.수방시간35.6(3～144)개월.응용Kaplan-Meier곡선화Log-Rank검험진행생존분석,Cox비례풍험회귀모형진행단、다인소분석.채용SPSS 19.0연건진행통계학분석.결과 112례환인중종류중위직경(8.4±3.1)cm (2.9～19.0 cm),AFP중위수평(6 453.8±47 699.2)μg/L(12.9～484 000.0 μg/L),종류PRETEXT Ⅰ、Ⅱ、Ⅲ、Ⅳ분기위3례(2.7％)、16례(14.3％)、42례(37.5％)、51례(45.5％),단발종류96례(85.7％),다발종류16례(14.3％),유원처전이자27례(24.1％),무원처전이자85례(75.9％).간모세포류환인혈관침범자25례,기중문정맥침범17례(68％),강정맥침범8례(32％).K-M생존곡선분석현시,영향간모세포류환인예후적위험인소포괄AFP수평、PRETEXT분기、종류단발다발、유무전이화혈관침범.환인혈청갑태단백(AFP)＜100 μg/L혹＞10 000 μg/L조(61례)5년생존솔위47％(28례/61례)교AFP재100～10 000 μg/L조(51례)71.3％(36/51)저;종류다발조(16례)5년생존솔위25.9％(4/16)교단발조(96례)68.8％(66/96)저;PRETEXTⅣ기고위조(51례)환인5년생존솔위41.8％(21/51)교PRETEXT Ⅰ、Ⅱ、Ⅲ기표준조(61례)71.7％(44/61)저;유전이조(27례)5년생존솔위24.3％(6/27)교무전이조(85례)67.9％(57/85)저;유혈관침범조(25례)5년생존솔위35％(9/25)교무혈관침범조(87례)64.3％(56/87)저.Cox비례풍험회귀모형다인소분석현시AFP＜100 μg/L혹＞10 000 μg/L(HR 2.454,95％CI 1.207～4.987,P=0.013); PRETEXT Ⅳ기(HR 2.817,95％CI 1.373～5.783,P=0.005);다발종류(HR 2.852,95％CI 1.256～6.475,P=0.012);원처전이(HR 2.654,95％CI 1.342～5.267,P=0.005);혈관침범(HR 2.272,95％CI1.102～4.687,P=0.026).결론 간모세포류환인예후여AFP수평、종류단발다발、PRETEXT분기、유무전이、혈관침범유관,재불동위험인소존재적정황하,간모세포류환인예후회유차이.
Objective To analyze the prognostic factors of hepatoblastoma (HB) after comprehensive treatment.Methods Between May 1,2001 and January 30,2012,retrospective analyses were conducted for 136 cases of pediatric hepatoblastoma.Their clinicopathological data and follow-up information were collected and analyzed.The treatment regimen was composed mostly of surgery plus chemotherapy.And chemotherapy was divided into preoperative and postoperative chemotherapies.For 112 cases,the follow-up period was 35.6 (3-144) months.Kaplan-Meier curve and Log-rank test were employed for survival analysis.Cox proportional hazard regression model was used for univariate and multivariate analyses.Statistical analysis was performed with SPSS 19.0 software.Results The median diameter of HB was 8.4 ± 3.1 (2.9-19.0) cm and the median AFP level 6 453.8 ± 47 699.2 (12.9-484 000.0) μg/L.The PRETEXT stages were Ⅰ (n =3,2.7 ％),Ⅱ (n =16,14.3 ％),Ⅲ (n =42,37.5％) and Ⅳ (n =51,45.5％).There were single tumor (n =96,85.7％),multiple tumors (n =16,14.3％),with distant metastasis (n =27,24.1％) and without distant metastases (n =85,75.9％).Vascular invasion occurred in 25 cases,including portal vein invasion (n=17,68 ％) and vena cava infringement (n =8,32％).K-M survival curve showed that prognostic factors of HB included level of AFP,PRETEXT staging,multiple single tumor,metastasis and vascular invasion.Serum alphafetoprotein (AFP)＜100 μg/L or AFP＞ 10 000 μg/L (28/61,47％) had lower 5-year survival rate than 100μg/L ＜AFP＜10,000 μg/L group (36/51,71.3％).And multiple tumors group (4/16,25.9％) had a lower 5-year survival rate than single tumor group (66/96,68.8％).As compared to PRETEXT stages Ⅰ,Ⅱ,Ⅲ group(44/61,71.7％),PRETEXT Ⅳ stage group(21/51,41.8％) had a lower 5-year survival rate.The 5-year survival rate of metastasis group (6/27,24.3％) was lower than that of metastasis group (57/85,67.9％) and the 5-year survival rate of vascular invasion group (9/25,35 ％) lower than that of without vascular invasion group (56/87,64.3 ％).Cox proportional hazard regression multivariate analysis showed that AFP ＜100 μg/L or＞ 10 000 μg/L (HR 2.454,95％CI 1.207-4.987,P =0.013) ; PRETEXT Ⅳ (HR 2.817,95％ CI 1.373-5.783,P =0.005) ; multiple tumors (HR 2.852,95％CI 1.256-6.475,P =0.012) ; distant metastasis (HR 2.654,95％CI 1.342-5.267,P =0.005) and vascular invasion (HR 2.272,95％ CI 1.102-4.687,P =0.026) were risk factors.Conclusions The prognosis of HB children is associated with AFP level,single tumor,PRETEXT stage,metastasis and vascular invasion.And prognosis may vary for different risk factors of HB.
