Hu Jiajian,Sun Jihang,Yang Shen,et al.Evaluation of chemotherapy for reducing operative complications of medium and high risk retroperitoneal neuroblastoma based on imaging-defined risk factor[J].Journal of Clinical Pediatric Surgery,,21():108-114.[doi:10.3760/cma.j.cn.101785-201909059-003]
Evaluation of chemotherapy for reducing operative complications of medium and high risk retroperitoneal neuroblastoma based on imaging-defined risk factor
- Keywords:
- Neuroblastoma/SU; Neuroblastoma/TH; Intraoperative Complications; Postoperative Complication; Antineoplastic Combined Chemotherapy Protocols; Child
- Abstract:
- Objective To research the role of neoadjuvant chemotherapy in reducing operative complications of medium and high risk retroperitoneal neuroblastoma based on the concept of imaging-defined risk factor (IDRF).Methods The whole clinical and surgical data of children with medium and high risk retroperitoneal neuroblastoma who underwent standardized chemotherapy and surgery from June 2016 to June 2017 in Beijing Children’s Hospital were retrospectively analyzed.IDRF were defined according to the international neuroblastoma risk group (INRG) standard.Changes in IDRF during diagnosis and treatment were recorded.We compared IDRF before and after chemotherapy in each patient.The correlation between the number of preoperative IDRF and the number of surgical complications was analyzed by spearman correlation coefficient method (P value<0.05 was statistically significant).Results A total of 53 cases were collected, including 22 boys and 31 girls.The age of onset ranged from 4 to 148 months, with an average of 39.60±28.70 months.The number of IDRFs ranged from 0 to 11 (median 4 items) before chemotherapy and from 0 to 11 (median 3 items) after chemotherapy.The change of IDRFs had statistical significance (P<0.05).A total of 74 complications occurred in 37 patients, with a maximum of 4 complications and a minimum of 0 complications (median of 1 complications) in each patient.There was a strong correlation between the number of operative complications and the number of preoperative IDRFs (r=0.687, P<0.05).Conclusion Chemotherapy can effectively reduce IDRF and surgical risk.IDRF is of great value in the assessment of surgical risk.
References:
[1] Reynolds CP,Lemons RS.Retinoid therapy of childhood cancer[J].Hematol Oncol Clin North Am,2001,15(5):867-910.DOI:10.1016/S0889-8588(05)70256-2.
[2] Yoneda A,Nishikawa M,Uehara S,et al.Can neoadjuvant chemotherapy reduce the surgical risks for localized neuroblastoma patients with image-defined risk factors at the time of diagnosis?[J].Pediatr Surg Int,2016,32(3):209-214.DOI:10.1007/s00383-016-3858-5.
[3] 胡嘉健,孙记航,陈艺伟,等.影像学危险因素对儿童腹膜后神经母细胞瘤手术并发症的预测价值研究[J].临床小儿外科杂志,2020,19(10):903-908.DOI:10.3969/j.issn.1671-6353.2020.10.008. Hu JJ,Sun JH,Chen YW,et al.Correlational research between image danger risk factor and surgical complications of retroperitoneal neuroblastoma in children[J].J Clinic Pediat Surg,2020,19(10):903-908.DOI:10.3969/j.issn.1671-6353.2020.10.008.
[4] 中国抗癌协会小儿肿瘤专业委员会,中华医学会小儿外科学分会肿瘤外科学组.儿童神经母细胞瘤诊疗专家共识[J].中华小儿外科杂志,2015,36(1):3-7.DOI:10.3760/cma.j.issn.0253-3006.2015.01.002. Professional Committee of Pediatric Cancer of China Anti-Cancer Association,Oncology Surgery Group of Pediatric Surgery Society of Chinese Medical Association.Expert Consensus on Diagnosis and Treatment of Neuroblastoma in Children[J].Chin J Pediatr Surg,2015,36(1):3-7.DOI:10.3760/cma.j.issn.0253-3006.2015.01.002.
[5] 马晓莉,金眉,张大伟,等.多学科联合诊治神经母细胞瘤91例临床特征及近期疗效分析[J].中华实用儿科临床杂志,2013,28(3):178-182.DOI:10.3760/cma.j.issn.2095-428X.2013.03.007. Ma XL,Jin M,Zhang DW,et al.Clinical features and efficacy of recent treatment analysis of multimodality treatment for 91 children with neuroblastoma[J].J Appl Clin Pediatr,2013,28(3):178-182.DOI:10.3760/cma.j.issn.2095-428X.2013.03.007.
[6] 杨深,蔡思雨,彭晓霞,等.中高危儿童神经母细胞瘤治疗过程中发生进展的预测及监测指标[J].中国小儿血液与肿瘤杂志,2018,23(2):62-68.DOI:10.3969/j.issn.1673-5323.2018.02.002. Yang S,Cai SY,Peng XX,et al.Prediction and monitoring indicators of the progression during the treatment of intermediate and high risk neuroblastoma[J].J Chin Pediatr Blood Cancer,2018,23(2):62-68.DOI:10.3969/j.issn.1673-5323.2018.02.002.
[7] 张金哲.小儿肿瘤外科手术技术规范[J].临床小儿外科杂志,2008,7(5):66-68.DOI:10.3969/j.issn.1671-6353.2008.05.023. Zhang JZ.Technical Specifications for Pediatric Oncology Surgery[J].J Clin Pediatr Surg,2008,7(5):66-68.DOI:10.3969/j.issn.1671-6353.2008.05.023.
[8] Brodeur GM,Pritchard J,Berthold F,et al.Revisions of the international criteria for neuroblastoma diagnosis,staging and response to treatment[J].Prog Clin Biol Res,1993,385(11):363-369.DOI:10.1200/JCO.1993.11.8.1466.
[9] 张广超,王景福.国际神经母细胞瘤危险度分级(INRG)协作组最新共识[J].中国肿瘤临床,2012,39(15):1003-1007.DOI:10.3969/j.issn.1000-8179.2012.15.001. Zhang GC,Wang JF.Recent consensus of the International Neuroblastoma Risk Group on Staging (INRG)[J].Chin J Clin Oncol,2012,39(15):1003-1007.DOI:10.3969/j.issn.1000-8179.2012.15.001.
[10] Brisse HJ,Mccarville MB,Granata C,et al.Guidelines for imaging and staging of neuroblastic tumors:consensus report from the international neuroblastoma risk group project[J].Radiol,2011,261(1):243-257.DOI:10.1148/radiol.11101352.
[11] Davidoff AM,Fernandez-Pineda I.Complications in the surgical management of children with malignant solid tumors[J].Semin Pediatr Surg,2016,25(6):395-403.DOI:10.1053/j.sempedsurg.2016.10.003.
[12] Akihiro Y,Masanori N,Shuichiro U,et al.Can image-defined risk factors predict surgical complications in localized neuroblastoma?[J].Eur J Pediatr Surg,2016,26(1):117-122.DOI:10.1055/s-0035-1566100.
[13] Maris JM,Hogarty MD,Bagatell R,et al.Neuroblastoma.[J].Lancet,2007,369(9579):2106-2120.DOI:10.1016/S0140-6736(07)60983-0.
[14] 汤静燕,潘慈,吴晔明,等.儿童实体瘤多专业联合诊治模式的探讨[J].中华儿科杂志,2001,39(8):498-500.DOI:10.3760/j.issn:0578-1310.2001.08.019. Tang JY,Pan C,Wu YM,et al.Study on the model of multi-specialty combined diagnosis and treatment of solid tumors in children[J].Chin J Pediatr,2001,39(8):498-500.DOI:10.3760/j.issn:0578-1310.2001.08.019.
[15] 胡嘉健,王焕民.儿童实体瘤的外科治疗[J].中国实用儿科杂志,2018,33(10):53-56.DOI:10.19538/j.ek2018100610. Hu JJ,Wang HM.Surgical treatment for solid tumor in children[J].Chin J Pract Pediat,2018,33(10):784-787.DOI:10.19538/j.ek2018100610.
[16] Sosnowska-Sienkiewicz P,Januszkiewicz-Lewandowska D,Losin M,et al.Arterial constriction after resection of neuroblastic tumors in children:Two-center retrospective study[J].Journal of Pediatric Surgery,2021,56(9):1661-1667.DOI:10.1016/j.jpedsurg.2021.04.030.
[17] 王智辉,孙晓非,甄子俊,等.术前化疗对54例晚期神经母细胞瘤患者手术切除率的影响[J].中国肿瘤临床,2006,33(10):580-582.DOI:10.3969/j.issn.1000-8179.2006.10.013. Wang ZH,Sun XF,Zhen ZJ,et al.The Effect of preoperative chemotherapy on resection rate of 54 cases with advanced neuroblastoma[J].Chin J Clin Oncol,2006,33(10):580-582.DOI:10.3969/j.issn.1000-8179.2006.10.013.
[18] Shamberger RC,Allarde-Segundo A,Kozakewich HP,et al.Surgical management of stage Ⅲ and Ⅳ neuroblastoma:Resection before or after chemotherapy?[J].J Pediatr Surg,1991,26(9):1113-1118. DOI:10.1016/0022-3468(91)90685-m.
[19] Leung CK.Fifteen years’ review of advanced childhood neuroblastoma from a single institution in Hong Kong[J].Chin Medic J,1998,111(5):466-469.
[20] 王健,曹东,顾文静,等.WHO标准与RECIST标准评价恶性肿瘤治疗效果的比较[J].中国基层医药,2013,20(5):652-654.DOI:10.3760/cma.j.issn.1008-6706.2013.05.005. Wang J,Cao D,Gu WJ,et al.Measuring response of treatment in malignant tumor:WHO versus RECIST criteria[J].Chin J Prim Med Pharm,2013,20(5):652-654.DOI:10.3760/cma.j.issn.1008-6706.2013.05.005.
[21] Cecchetto G.Surgical risk factors in primary surgery for localized neuroblastoma:the lnesg1 study of the european international society of pediatric oncology neuroblastoma group[J].J Clin Oncol,2005,23(33):8483-8489.DOI:10.1200/JCO.2005.02.4661.
[22] Monclair T,Mosseri V,Cecchetto G,et al.Influence of image-defined risk factors on the outcome of patients with localised neuroblastoma.A report from the LNESG1 study of the european international society of paediatric oncology neuroblastoma group[J].Pediatr Blood Cancer,2015,62(9):1536-1542.DOI:10.1002/pbc.25460.
[23] Varan A,Kesik V, ?enocak ME,et al.The efficacy of delayed surgery in children with high-risk neuroblastoma[J].J Cancer Res Ther,2015,11(2):268.DOI:10.4103/0973-1482.151852.
[24] Irtan S,Brisse HJ,Minard-Colin V,et al.Image-defined risk factor assessment of neurogenic tumors after neoadjuvant chemotherapy is useful for predicting intra-operative risk factors and the completeness of resection[J].Pediatr Blood Cancer,2015,62(9):1543-1549.DOI:10.1002/pbc.25511.
[25] Avanzini S,Pio L,Erminio G,et al.Image-defined risk factors in unresectable neuroblastoma:SIOPEN study on incidence,chemotherapy-induced variation,and impact on surgical outcomes[J].Pediatr Blood Cancer,2017,64(11):e26605.DOI:10.1002/pbc.26605.
[26] Rojas Y,Jaramillo S,Lyons K,et al.The Optimal Timing of Surgical Resection in High-risk Neuroblastoma[J].J Pediatr Surg,2016,51(10):1665-1669.DOI:10.1016/j.jpedsurg.2016.05.021.
[27] Shamberger RC,Smith EI,Joshi VV,et al.The risk of nephrectomy during local control in abdominal neuroblastoma[J].J Pediatr Surg,1998,33(2):161-164.DOI:10.1016/s0022-3468(98)90424-9.
[28] Akihiro Y,Masanori N,Shuichiro U,et al.Can Image-Defined Risk Factors Predict Surgical Complications in Localized Neuroblastoma?[J].Eur J Pediatr Surg,2016,26(1):117-122.DOI:10.1055/s-0035-1566100.
[29] Fumino S,Kimura K,Iehara T,et al.Validity of image-defined risk factors in localized neuroblastoma:A report from two centers in Western Japan[J].J Pediatr Surg,2015,50(12):2102-2106.DOI:10.1016/j.jpedsurg.2015.08.039.
Memo
收稿日期:2020-09-23。
基金项目:中国工程院咨询研究课题（2019-XY-34）
通讯作者:王焕民,Email:wanghuanmin@bch.com.cn