Liu Tao,Sheng Qingfeng,Liu Jiangbing,et al.Risk factors related to 3-year EFS in International Neuroblastoma Staging System stage 4 neuroblastoma patients[J].Journal of Clinical Pediatric Surgery,2022,21(02):121-127.[doi:10.3760/cma.j.cn.101785-202011036-005]
INSS 4期神经母细胞瘤患儿3年无事件生存率的相关因素分析
- Title:
- Risk factors related to 3-year EFS in International Neuroblastoma Staging System stage 4 neuroblastoma patients
- 关键词:
- 神经母细胞瘤/外科学; 抗肿瘤联合化疗方案; 肿瘤转移; 预后
- Keywords:
- Neuroblastoma/SU; Antineoplastic Combined Chemotherapy Protocols; Neoplasm Metastasis; Prognosis
- 摘要:
- 目的 探讨影响INSS 4期神经母细胞瘤患儿3年无事件生存率（event-free survival，EFS）的相关因素。方法 回顾性分析2014年4月至2020年4月经上海市儿童医院确诊和完善评估的68例INSS 4期神经母细胞瘤患儿临床资料。收集患儿年龄、性别、神经元烯醇化酶（neuron specific enolase，NSE）、乳酸脱氢酶（1actate dehydrogenase，LDH）、24小时尿香草扁桃酸（vanillylmandelic acid，VMA）及肿瘤病理类型等信息。采用Kaplan-Meier法进行生存分析，采用Cox回归模型进行预后相关因素分析。随访时间1~60个月，平均随访时间21个月。结果 68例INSS 4期神经母细胞瘤患儿中，男46例，女22例；发病年龄7~120个月，中位年龄35个月。其中48例（70.6%）伴骨髓转移，47例（69.1%）骨转移，17例（25.0%）远处淋巴结转移，9例（13.2%）肝转移，5例（7.4%）脑转移，4例（5.9%）眼眶转移，20例（29.4%）存在胸膜、皮肤等其他部位转移。单因素分析结果显示，患儿3年EFS与LDH、NSE、MYCN基因、骨转移、颅内转移（包括脑转移和眼眶转移）有关（P<0.05）。Cox回归分析结果显示，颅内转移（RR=4.179，95%CI=1.112~15.703，P=0.034）及血清LDH>587 U/L（RR=3.729，95%CI=1.116~12.466，P=0.033）是INSS 4期神经母细胞瘤患儿独立的预后相关因素。结论 颅内转移、血清LDH>587 U/L与INSS 4期神经母细胞瘤患儿3年EFS相关。
- Abstract:
- Objective To explore the risk factors related to 3-year event-free survival (EFS) in patients with International Neuroblastoma Staging System (INSS) stage 4 neuroblastoma (NB).Methods A retrospective analysis of 68 patients diagnosed and completely evaluated with INSS stage 4 neuroblastoma from April 2014 to April 2020 was performed.Patients’ information including age, gender, neuron specific enolase (NSE), 1actate dehydrogenase (LDH), vanillylmandelic acid (VMA), pathologic type, and so on were collected.Kaplan-Meier method and Cox regression were used for survival and prognostic factors analysis respectively.Follow-up in all patients ranged from 1 to 60 months (mean 21).Results Of the 68 patients (46 male, 22 female) with INSS stage 4 neuroblastoma, the median age of onset was 35 months (7-120 months).There were 48 cases (70.6%) of bone marrow metastases, 47 cases (69.1%) of bone metastases, 17 cases (25.0%) of distant lymph node metastases, 9 cases (13.2%) of liver metastases, 5 cases (7.4%) of brain metastases 4 cases (5.9%) of orbital metastases, and 20 cases (29.4%) of other metastases.The univariate analysis revealed that 3-year EFS was associated with LDH, NSE, MYCN gene, bone metastasis, and intracranial metastasis (including brain metastases or orbital metastases) (P<0.05).The Cox analysis showed that intracranial metastasis (RR=4.179, 95%CI=1.112~15.703, P=0.034) and LDH>587 U/L (RR=3.729, 95%CI=1.116~12.466, P=0.033) were independent prognosis factors.Conclusion For patients with INSS stage 4 neuroblastoma, intracranial metastasis and LDH>587 U/L were independent prognosis factors for 3-year EFS.
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备注/Memo
收稿日期:2020-09-02。
通讯作者:吕志宝,Email:zhibaolyu@163.com