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目的探讨伴骨髓转移的高危神经母细胞瘤(NB)患者治疗后骨髓缓解速度对预后的影响。方法收集中山大学肿瘤防治中心从2000年1月至2014年12月收治的初诊时已有骨髓转移的Ⅳ期高危NB患者的临床资料。将≤2个疗程化疗后骨髓获得完全缓解(CR)定义为快速骨髓缓解组,>2个程化疗后骨髓获得CR定义为缓慢骨髓缓解组。并对综合治疗后获得CR或非常好的部分缓解(VGPR)的73例患者的预后进行单因素和多因素分析。结果纳入分析的73例患者,中位年龄4.0(1.6~9.8)岁,男52例、女2l例。快速骨髓缓解组19例,缓慢骨髓缓解组54例。全组4年无事件生存率(EFS)和总生存率(OS)分别为(15.6±4.9)%和(28.9±6.4)%。快速骨髓缓解组与缓慢骨髓缓解组4年EFS分别为(25.9±12.3)%和(12.4±5.0)%(P=0.033),4年0S分别为(51.6±15.2)%和(22.6±6.6)%(P=0.057)。单因素分析结果显示,骨髓缓慢缓解是影响骨髓转移的高危NB患儿EFS的不良因素(P<0.05);无维持药物治疗、N-myc基因扩增是影响0S的不良因素(P<0.05)。多因素分析结果示,N-MYC扩增、骨髓缓慢缓解为患者0S的独立不良预后因素(P<0.05);仅骨髓缓慢缓解是EFS的独立不良预后因素(P<0.05)。年龄≤2岁NB患者骨髓快速缓解的比例高于年龄>2岁患者(x~2=5.608,spearman相关系数=0.277,P=0.018)。结论本研究显示骨髓转移的高危NB患者治疗后骨髓快速缓解者预后好于缓慢骨髓缓解者,有可能作为骨髓转移的高危NB患者的预后观察指标之一。
Objective To investigate the effect of bone marrow remission rate on prognosis in patients with high-risk neuroblastoma (NB) with bone marrow metastasis. Methods The clinical data of patients with stage Ⅳ high risk NB who had bone marrow metastasis at the newly diagnosed center of Sun Yat-sen University Cancer Center from January 2000 to December 2014 were collected. Complete bone marrow resolution (CR) ≤2 courses after chemotherapy was defined as a rapid bone marrow remission group, and bone marrow acquired CR> 2 courses after chemotherapy was defined as a slow bone marrow remission group. Univariate and multivariate analyzes were performed on the prognosis of 73 patients who received CR or very good partial response (VGPR) after combination therapy. Results The 73 patients included in the analysis had a median age of 4.0 (1.6-9.8 years), 52 males and 21 females. 19 cases of rapid bone marrow remission group, 54 cases of slow bone marrow remission group. The overall 4-year event-free survival (EFS) and overall survival (OS) were (15.6 ± 4.9)% and (28.9 ± 6.4)%, respectively. The 4-year EFS were (25.9 ± 12.3)% and (12.4 ± 5.0)%, respectively (P = 0.033) and 0 (51.6 ± 15.2) and (22.6 ± 6.6) % (P = 0.057). Univariate analysis showed that slow bone marrow remodeling was an adverse factor of EFS in high-risk NB children with bone marrow metastasis (P <0.05). No maintenance drug treatment and N-myc gene amplification were the adverse factors affecting OS (P0.05) . Multivariate analysis showed that N-MYC amplification and slow bone marrow recovery were independent prognostic factors of OS in patients with OS (P <0.05). Only slow bone marrow remodeling was an independent prognostic factor of EFS (P <0.05). The rate of bone marrow remission in NB patients aged ≤ 2 years was higher than that in patients> 2 years (x 2 = 5.608, spearman correlation coefficient = 0.277, P = 0.018). CONCLUSIONS: This study shows that patients with high-risk NB patients with bone marrow metastasis have a better prognosis than patients with slow-response bone marrow after treatment and may be one of the prognostic indicators for high-risk NB patients with bone marrow metastasis.