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目的探讨4期神经母细胞瘤(NB)患儿的综合治疗效果及预后。方法回顾性分析95例4期NB患儿,根据患儿接受的治疗方案,比较NB09方案及非NB09方案的疗效差别,并分析影响4期患儿预后的相关因素。全组患儿中位年龄48个月(4~136个月),中位随访时间21个月(4~179个月),NB09方案治疗患儿40例,非NB09方案治疗55例。结果 NB09组患儿3年总生存率(OS)及无疾病进展生存率(PFS)情况均明显好于非NB09组(χ~2分别为6.916和10.025,P<0.05)。对全组患儿预后行单因素分析,治疗方案、病理类型、骨髓受累>20%、N-MYC扩增、手术范围、是否维甲酸诱导、乳酸脱氢酶(LDH)>1 000 U/L及短期疗效达非常好的部分缓解(VGPR)为影响全组患儿预后的因素。多因素分析显示,影响整组患儿预后的独立因素为骨髓受累>20%(P<0.05)。结论接受了NB09方案治疗的4期患儿预后较其他患儿好,骨髓受累>20%的4期患儿预后差,需加强治疗强度。
Objective To investigate the combined treatment and prognosis of children with stage 4 neuroblastoma (NB). Methods Ninety-five patients with stage 4 NB were retrospectively analyzed. The differences of efficacy between NB09 and non-NB09 regimens were compared according to the treatment regimen received in children. The related factors influencing the prognosis of stage 4 children were analyzed. The median age of the patients was 48 months (range, 4 to 136 months) with a median follow-up of 21 months (range, 4 to 179 months). Forty children with NB09 regimen and 55 non-NB09 regimen were included. Results The overall 3-year survival rate (OS) and progression-free survival (PFS) of patients in NB09 group were significantly better than those in non-NB09 group (χ ~ 2 = 6.916 and 10.025, P <0.05). Univariate analysis, treatment regimen, histological type, bone marrow involvement> 20%, N-MYC amplification, operative range, retinoic acid induced lactate dehydrogenase (LDH)> 1 000 U / L And short-term efficacy of very good partial response (VGPR) as a factor affecting the prognosis of the whole group of children. Multivariate analysis showed that the independent factor affecting the prognosis of the whole group was bone marrow involvement> 20% (P <0.05). Conclusion The prognosis of stage 4 children undergoing NB09 regimen is better than that of other children. Stage 4 infants with bone marrow involvement> 20% have poor prognosis and require intensive treatment.