Li Zhuo,Cheng Lin,Han Lulu,et al.Treatment decision-making and short-term outcomes for hepatoblastoma based upon tumor volume proportion[J].Journal of Clinical Pediatric Surgery,2026,(04):355-359.[doi:10.3760/cma.j.cn101785-202507010]
基于肿瘤体积占比的肝母细胞瘤治疗决策及短期效果分析
- Title:
- Treatment decision-making and short-term outcomes for hepatoblastoma based upon tumor volume proportion
- Keywords:
- Hepatoblastoma; Tumor Burden; Chemotherapy; Adjuvant; Imaging; Three-Dimensional; Treatment Outcome; Child
- 摘要:
- 目的 通过分析肿瘤体积与治疗方案选择的相关性以及短期内治疗效果,探讨不同肿瘤体积占比肝母细胞瘤(hepatoblastoma,HB)患儿手术时机与治疗方案,为优化临床决策提供依据。方法 本研究为回顾性队列研究。收集2014年1月至2024年12月青岛大学附属医院收治的59例HB患儿临床资料,患儿均通过Hisense CAS对各个阶段(初始治疗前、化疗后及手术后)的CT影像数据进行三维重建,测量不同阶段肿瘤以及正常肝脏的体积,并计算出肿瘤体积占比[肿瘤体积/(正常肝脏体积+肿瘤体积)×100%]。根据肿瘤体积占比分为两组:<50%为小体积占比组(27例),≥50%为大体积占比组(32例)。比较两组内直接手术与术前接受新辅助化疗两种治疗策略患儿的围手术期指标(术中出血量、术后恢复时间及剩余肝比例)。结果 59例均手术顺利,无一例发生术中并发症。小体积占比组27例中,直接手术17例,术前化疗10例;直接手术患儿术中出血量[8.50(6.00,17.50)mL]少于术前化疗患儿[20.00(10.00,60.00)mL],差异具有统计学意义(P=0.014),而术后肝功能恢复正常时间(P=0.388)、剩余肝比例(P=0.396)差异无统计学意义。大体积占比组32例中,直接手术10例,术前化疗22例;术前化疗患儿剩余肝所占比例[89.25(84.42,93.33)%]较直接手术患儿[80.91(77.24,84.93)%]高,差异具有统计学意义(P=0.004);术前化疗患儿术后肝功能恢复正常时间[7.00(6.00,9.08)天]较直接手术患儿[9.00(7.08,11.83)天]短,差异具有统计学意义(P=0.037);而术中出血量差异无统计学意义(P=0.194)。结论 直接手术和术前予新辅助化疗两种方案治疗HB均具有良好的短期效果。对于肿瘤体积占比较小的患儿,直接手术出血量更少;对于肿瘤体积占比较大的患儿,术前化疗可使剩余肝所占比例提高,术后恢复时间缩短,但需进一步临床研究证实。
- Abstract:
- Objective To explore the timing of surgery and treatment strategies for hepatoblastoma (HB) children with varying tumor volume proportions through examining the correlation between tumor size and treatment selection,thereby providing evidence for optimizing clinical decision-making.Methods For this retrospective case series study,the relevant clinical data were collected from 59 HB children between January 2014 and December 2024.All of them underwent Hisense CAS three-dimensional reconstruction at various stages of pre-initial treatment,post-initial treatment and post-revision surgery.Tumor and normal liver volumes were measured at multiple stages (pre-initial treatment,post-chemotherapy & post-surgery) using Hisense CAS three-dimensional reconstruction CT imaging data.Tumor volume proportion was calculated as[tumor volume/(normal liver volume + tumor volume)×100%].They were categorized into two groups based upon tumor volume proportion: <50% as small volume proportion group (n=27) while ≥50% as large volume proportion group (n=32).Perioperative indicators were compared between direct surgery and preoperative neoadjuvant chemotherapy within each group,including: intraoperative volume of blood loss,postoperative recovery time and residual liver ratio.Results All procedures were uneventful without intraoperative complications.Within small volume group: Intraoperative volume of blood loss was significantly lower in direct surgery group than that in preoperative chemotherapy group[8.50(6.00,17.50) vs.20.00(10.00,60.00)mL](P=0.014).However,postoperative recovery time (P=0.388) and remaining liver volume ratio (P=0.396) showed no statistically significant differences.Within large-volume proportion group,direct surgery (n=10) and preoperative chemotherapy (n=22) were performed; Residual liver volume in children on preoperative chemotherapy was significantly higher than that in those undergoing direct surgery[89.25(84.42,93.33)% vs.80.91(77.24,84.93)%](P=0.004); Postoperative recovery time for children on preoperative chemotherapy was also significantly shorter than that for those undergoing direct surgery[7.00(6.00,9.08) vs.9.00(7.08,11.83) day](P=0.037).However,no statistically significant difference existed in intraoperative volume of blood loss (P=0.194).Conclusions Both approaches have demonstrated favorable outcomes for hepatoblastoma.For children with smaller tumor-to-liver ratios,direct surgery resulted in lower intraoperative blood loss.For those with larger tumor-to-liver ratios,preoperative chemotherapy boosted the proportion of residual liver and shortened postoperative recovery time.However,further clinical studies are required for confirming these findings.
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备注/Memo
收稿日期:2025-7-5。
基金项目:泰山学者攀登专家项目(tspd20240820);国家杰出医师项目(qyfy5080)
通讯作者:陈鑫,Email:m15506399877@163.com;董蒨,Email:qdupediatrsurg@163.com