Yu Jianzhong,Shi Wei,Zhao Rui,et al.Clinical characteristics and prognostic factors of pediatric medulloblastoma[J].Journal of Clinical Pediatric Surgery,2020,19(03):236-240,247.[doi:10.3969/j.issn.1671-6353.2020.03.009]
儿童髓母细胞瘤的临床特点及预后相关因素分析
- Title:
- Clinical characteristics and prognostic factors of pediatric medulloblastoma
- Keywords:
- Medulloblastoma; Clinical Factor; Prognosis; Child
- 分类号:
- R726;R739.42
- 摘要:
- 目的 通过分析儿童髓母细胞瘤的临床特点、治疗方法和患者预后的关系，探索影响儿童髓母细胞瘤预后相关因素。方法 收集2004年至2014年复旦大学附属儿科医院收治且术后病理证实为髓母细胞瘤患儿的病例资料，对所收集数据进行分组，采用单因素Kaplan-Meier法进行生存分析，统计各组病人的总体生存时间及累计生存率，采用Log-Rank检验分析各组病人累计生存率差异，采用Cox回归进行多因素分析，探讨儿童髓母细胞瘤临床因素与生存时间、生存结局的关联性。结果 单因素分析结果认为，临床症状阳性数（P=0.039）、M分期（P=0.009）、术后放疗（P=0.001）、术后化疗（P=0.018）、肿瘤复发（P=0.04）是髓母细胞瘤患儿预后的影响因素；Cox多因素分析结果认为术后放疗（OR=0.291，95%置信区间：0.120~0.706，P=0.006）和化疗（OR=0.095，95%置信区间：0.024~0.384，P=0.001）是影响髓母细胞瘤患儿预后的保护因素；性别、年龄、肿瘤位置、T分期、肿瘤切除程度、病理分型等因素未发现与预后有关（P>0.05）。结论 术后是否接受放疗、化疗对患儿预后影响较大，而临床症状的个数、M分期、肿瘤复发对患儿预后的判断价值有限，性别、年龄、肿瘤位置、T分期、肿瘤切除程度、病理分型等因素则与预后无关。
- Abstract:
- Objective To explore the association of clinical characteristics and treatment regimens with the prognosis of pediatric medulloblastoma.Methods Retrospective review was performed for clinical data of 40 hospitalized children with medulloblastoma.Statistical analyses were conducted by Kaplan-Meier survival curve.And log-rank test was employed for determining the significance of differences.Cox multiple regression analysis was performed for identifying the clinical factors associated with overall survival.Results Univariate analysis indicated that more positive symptoms (P=0.039),advanced M stage (P=0.009),postoperative radiotherapy (P=0.001),chemotherapy(P=0.018) and tumor recurrence(P=0.04) were associated with poor disease-free survival.Multiple regression analysis indicated that post-surgical radiotherapy (OR=0.291,95%CI:0.120-0.706,P=0.006)and chemotherapy(OR=0.095,95%CI:0.024-0.384,P=0.001)were independently associated with poor prognosis.Gender,age,tumor location,T stage,extent of resection and histologic type were unrelated to survival (P>0.05).Conclusion Postoperative chemoradiotherapy is associated strongly with the survival of medulloblastoma while number of positive symptoms,M stage and recurrence have some limited prognostic value.No correlation exists between gender,age,tumor location,T stage,extent of resection,histologic type or survival.
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备注/Memo
收稿日期:2019-12-05。
基金项目:上海市卫生和计划生育委员会科研课题（青年项目）（编号：20164Y0086）；上海市抗癌协会青年医生"雏鹰"项目（编号：SACA-CY1C03）
通讯作者:李昊,Email:lihao7272@163.com